Intestinal perforation in very-low-birth-weight infants with necrotizing enterocolitis ☆,☆☆ Nehama Linder a,b,c , Naama Hammel b , Adriana Hernandez b , Elena Fridman b, ⁎ , Elena Dlugy d , Tina Herscovici a , Gil Klinger a,c a Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel b Department of Neonatology, Rabin Medical Center, Petach Tikva, Israel c Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel d Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel Received 29 March 2012; revised 19 August 2012; accepted 20 August 2012 Key words: Risk factors; Necrotizing enterocolitis; Perforation; Very low birth weight Abstract Purpose: To identify risk factors for intestinal perforation in very-low-birth-weight (VLBW) infants with necrotizing enterocolitis (NEC). Methods: Retrospective case–control study over a 10-year period, using univariate and multivariate logistic regression analyses to compare all VLBW infants treated for perforated NEC, with two age and weight-matched groups: infants with non-perforated NEC and infants without NEC. Results: Twenty infants with perforated NEC were matched to 20 infants with non-perforated NEC and 38 infants without NEC. Infants with perforated NEC were younger (p b 0.01) and had higher rates of abdominal distention, metabolic acidosis, hyperglycemia and elevated liver enzymes (p b 0.05). On logistic regression analysis, abdominal distention was associated with an increased risk of intestinal perforation (OR 39.8, 95% CI 2.71–585) and late onset of NEC (one-day increments) was associated with a decreased risk (OR 0.93, 95% CI 0.87–1.0). Conclusion: Identification of abdominal distention at an early age in VLBW infants should lead to increased vigilance for signs of perforated NEC and may enable early intervention. © 2013 Elsevier Inc. All rights reserved. Necrotizing enterocolitis (NEC) is an acquired intestinal disease associated with prematurity [1]. The incidence is inversely related to both birth weight and gestational age [2-5]; recent cohort studies have reported NEC rates of 3% to 7% among very low birth weight (VLBW) infants [2,6], with a wide variation among centers [2]. The incidence of NEC has not decreased over the years [2,7], possibly owing to advances in neonatal care that have improved survival of the smallest infants, who are at the highest risk. The mortality rate in VLBW infants ranges from 12% to 30% in infants not requiring surgery [2], and in- creases to 38%–50% if surgical intervention is required [2,5,6]. Survivors are at an increased risk of a myriad of complications directly related to the disease, such as sepsis, Abbreviations: VLBW, very low birth weight; NEC, necrotizing enterocolitis; NICU, Neonatal Intensive Care Unit. ☆ Conflict of interest: none. ☆☆ Funding: none. ⁎ Corresponding author. Department of Neonatology, Rabin Medical Center, 2 Denmark St., Petach Tikva, 49100, Israel. Tel.: +972 3 9377474; fax: +972 3 9377469. E-mail address: slomovel@gmail.com (E. Fridman). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpedsurg.2012.08.025 Journal of Pediatric Surgery (2013) 48, 562–567