Clinico-Aetiological Spectrum of Neonates Presenting with Pneumoperitoneum: A Case Series

Neonatal pneumoperitoneum, the presence of free air in the peritoneal cavity, signifies a critical surgical emergency with a spectrum of underlying aetiologies and clinical presentations. This case series of 5 neonates talks about our institutional experience with neonates diagnosed with pneumoperitoneum, aiming to delineate the clinical characteristics, etiological spectrum, diagnostic pathways utilizing radiographic protocol within your, management strategies, and outcomes. We analyzed data of 5 neonates presenting with pneumoperitoneum between. Our findings reveal a diverse range of primary causes, including e. g., necrotizing enterocolitis, bowel perforation, congenital anomalies. The utility of the radiographs of abdomen in the timely diagnosis and identification of pneumoperitoneum and its potential associated findings will be highlighted. Furthermore, we will discuss the varied surgical and non - surgical management approaches employed and their correlation with patient outcomes, including morbidity and mortality. This study underscores the importance of a high index of suspicion and a systematic diagnostic and management algorithm for neonates presenting with this life - threatening condition. Methods: Five neonates presenting with spontaneous bowel perforation were analyzed with respect to clinical presentation, management and outcome. Results: Out of 5 neonates, 3 (60%) were very low birth weight, 1 (20%) was low birth weight.4 (80%) out of 5 neonates were low birth weight, only 1 had birth weight above 2.5kg. [6] out of 5 neonates, 2 (40%) were very preterm (28 to less than 32 weeks), 2 (40%) were moderate to late preterm (32 to 37 weeks). Only 1 (20%) neonate was born full term. Out of 5 neonates, 2 (40%) developed symptoms within 72 hours of birth, 2 (40%) presented after 72 hours till 1 week. Only 1 neonate presented after 1 week of life. All the neonates in the series had Abdominal distension as the primary complaint (100%). Other symptoms noticed were blood in stools in 1 of them, while other neonate also had history of not passed meconium since birth.4 (80%) out of 5 neonates had systemic haemodynamic disturbances in the form of shock, hypoglycemia 1 (20%), hyponatremia 2 (40%), metabolic acidosis 2 (40%), convulsions 1 (20%), Respiratory failure 1 (20%). Among the post - operative complications, sepsis was the commonest in 4 (80%) neonates, followed by surgical site infection 1 (20%), enterocutaneous fistula 1 (20%) and DIC 1 (20%). Out of 5, 4 neonates could not survive due to the prematurity and sepsis related complications. Conclusions: Neonatal pneumoperitoneum remains a surgical emergency and outcome can be lethal if the problem is not addressed early. Given the alarmingly high mortality rate of approximately 80% in pneumoperitoneum, coupled with the prevalence of significant complications, the findings underscore a critical need for comprehensive re - evaluation and targeted interventions.