RESUMO
OBJECTIVE: To assess incidence and effect of delayed diagnosis of spontaneous intestinal perforation (SIP). STUDY DESIGN: Retrospective case series review of 58 VLBW neonates with SIP at our institution. RESULT: SIP was diagnosed in 6.1%, 10%, and 15.1% of VLBW, ELBW, and ≤750 g neonates, respectively. Abdominal distension (58.6%) and abdominal discoloration (53.4%) were the most common presenting signs/symptoms. Smaller (≤750 g) neonates were more likely to present with hypotension and higher FiO2, and larger (751-1500 g) neonates with increased abdominal girth and abdominal distension. All but one neonate had radiographic pneumoperitoneum, and 25.9% had pneumoperitoneum on an X-ray prior to the X-ray at SIP diagnosis. An education module reduced delay in SIP diagnosis. CONCLUSION: SIP presentation varies by birth weight and gestational age. Since SIP diagnosis is often first suggested on X-ray, all X-rays of VLBW neonates in the first 2 weeks of life should be scrutinized for pneumoperitoneum.