Focal intestinal perforation in late preterm and term neonates with hypoxic ischemic encephalopathy

Abstract

a b s t r a c tFocal intestinal perforation (FIP) is a significant cause of morbidity and mortality in extremely low birth weight neonates. In late preterm or term neonates, birth asphyxia is a risk factor for FIP, although recent reports of FIP in these patients are limited. We describe two cases of FIP, one in a late preterm neonate and one in a term neonate, both associated with hypoxic ischemic encephalopathy. Potential risk factors and pathophysiological mechanisms of FIP in late preterm and term neonates are discussed. Ó 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Gastrointestinal perforations without an identifiable cause, commonly referred to as idiopathic-, localized-, spontaneous, or focal intestinal perforations can occur in neonates, children, and adults [1,2]. In preterm neonates, these gastrointestinal perforations typically occur in extremely low birth weight (ELBW) infants, and appear to be associated with specific risk factors such as chorioamnionitis and exposure to postnatal steroids with or without indomethacin treatment [3e5]. In term neonates, although not as common, gastrointestinal perforations have been associated with birth asphyxia [6,7].Since perforations in neonates are usually associated with specific risk factors it may be preferable to describe the bowel injury as a "focal" intestinal perforation (FIP) [8,9], which alludes to the extent of injury rather than "spontaneous" intestinal perforation, which suggests that these risk factors are only coincidental. Histopathologically, FIP is characterized by focal intestinal perforations with necrosis of the muscularis externa and no ischemic damage [10]. Most of the recent literature on FIP discusses cases in ELBW neonates and reports of late preterm or term neonates with FIP are uncommon. We describe two cases of FIP, one in a late preterm neonate and one in a term neonate, both associated with hypoxic ischemic encephalopathy (HIE).

Global Hypoxia-Ischemia Induced Inflammation and Structural Changes in the Preterm Ovine Gut Which Were Not Ameliorated by Mesenchymal Stem Cell Treatment

“…as this region of the intestine is primarily affected in cases of perinatal asphyxia and NEC (42,43).…”