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Spontaneous intestinal perforation (SIP) will soon become the most common form of surgical bowel disease in the extremely low birth weight (ELBW) infant

Journal of Perinatology volume 42, pages 423–429 (2022)Cite this article

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Abstract

Recent data have revealed declines in the prevalence rates of NEC over the last decade in premature infants. In contrast, SIP has either remained steady or risen during the same epoch. These trends are consistent with our knowledge of the clinical arena. The ability to discern SIP contamination within NEC datasets has slowly improved. Additionally, quality improvement efforts are being utilized to reduce NEC through stewardship of antibiotics, acid inhibitors, central lines and blood products, as well as optimization of human milk diets. These forces are moving us to a new era, where NEC will no longer be the dominant surgical intestinal disease of the extremely preterm neonate. Indeed, in the extremely low birth weight (ELBW) population, SIP may already be the most prevalent reason for abdominal surgery. In this perspective, the reader will find supporting data and references for these assertions as well as predictions for the future.

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Fig. 1: NEC is decreasing.
Fig. 2: SIP surpasses surgical NEC in infants <25 weeks.
Fig. 3: SIP confounds probiotic trials.
Fig. 4: Better definitions for NEC and SIP.

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Authors and Affiliations

  1. Division of Neonatology, University of Virginia Children’s Hospital, Charlottesville, VA, USA

    Jonathan R. Swanson

  2. Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Amy Hair

  3. Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL, USA

    Reese H. Clark

  4. Infirmary Health Neonatology, Mobile Infirmary, Mobile, AL, USA

    Phillip V. Gordon

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Contributions

All authors conceived and designed the manuscript. RHC contributed to data acquisition and all authors contributed to data analysis. JRS and PVG drafted the original manuscript. AH and RHC reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable to all aspects of the work.

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Correspondence to Jonathan R. Swanson.

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Competing interests

JRS is an associate editor for the Journal of Perinatology and has received speaking honoraria from Prolacta Bioscience, Inc. AH receives research support from Prolacta Bioscience for the investigator-initiated randomized cream trial. PVG and RHC have no conflicts to disclose.

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Swanson, J.R., Hair, A., Clark, R.H. et al. Spontaneous intestinal perforation (SIP) will soon become the most common form of surgical bowel disease in the extremely low birth weight (ELBW) infant. J Perinatol 42, 423–429 (2022). https://doi.org/10.1038/s41372-022-01347-z

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