Laboratory Data for Predicting Spontaneous Intestinal Perforation – a Case Control Study

Background: Spontaneous intestinal perforation (SIP) of the preterm infants is defined as a single intestinal perforation. SIP is a separate clinical entity from necrotizing enterocolitis (NEC). The incidence of SIP in very low birth weight preterm infants (VLBW) is 2-3% and up to 10% in extremely low birth weight (ELBW). Significant laboratory findings in the diagnosis of SIP are missing. Early identification of SIP might reduce mortality and morbidity.

Methods: We designed this retrospective case-control study. To each included case of SIP the next consecutive gestational age (GA≤34) and birth-weight-matched case of NEC was recruited. We recorded glucose and lactate serum levels assessed on the day of SIP or NEC diagnosis.

Results: Thirty-two infants diagnosed with either SIP or NEC, born between 2010 and 2020 at the Tel Aviv Medical Center were included. The SIP and NEC groups did not differ in terms of maternal and neonatal demographics and mortality rate. Platelets count (K/µl) was lower in the SIP group (144.1±69) than in the NEC group (372.8±222.2), (p<.001). The SIP group showed less cases of hyperlactataemia than the NEC group (12.5% versus 50%, respectively, p=.022). Infants with SIP were diagnosed earlier (5.4±2.7 in days) than infants with NEC (21.5±13.4), (p<.001). Glucose strongly correlated with lactate serum levels in the NEC group (r(14)=.63, p=.01), and inversely correlated with lactate in the SIP group (r(14)=-.66, p=.006).

Conclusion: In SIP preterm infants, we found a negative relationship between glucose and lactate levels as opposed to NEC. We suggest that VLBW or ELBW babies should be monitored closely for glucose levels, so that any glucose increase with a normal level of lactate would be a suspicion for SIP.