key: cord-0712968-ut8e9n9n
authors: Harahap, Aminuddin; Harianto, Agus; Etika, Risa; Utomo, Martono Tri; Angelika, Dina; Handayani, Kartika Darma; Arif Sampurna, Mahendra Tri
title: Spontaneous Ileum Perforation in a premature twin with Coronavirus-19 positive mother
date: 2021-02-04
journal: J Pediatr Surg Case Rep
DOI: 10.1016/j.epsc.2021.101807
sha: 3c2dad58fcb844bb17051d5c8d32906b7f8461c6
doc_id: 712968
cord_uid: ut8e9n9n

Spontaneous intestinal perforation (SIP) of the newborn is a single intestinal perforation commonly found in the terminal ileum without distinct causes. These cases often associated with prematurity. The new COVID-19 in pregnancy increased the risk of premature rupture of membranes, preterm delivery, intrauterine fetal death (IUFD), and low birth weight (LBW). Here we report a premature twin with SIP that was born from Coronavirus-19 positive mother.

Spontaneous intestinal perforation (SIP) is a single intestinal perforation typically involving 51 the distal ileum's antimesenteric border and usually occurs in the extremely premature infant in 52 the first 1 to 2 weeks of life [1] . SIP is the second common cause of intestinal perforation in 53 neonates, especially in low-birth-weight newborn, the incidence rate is 1.1% in very low birth 54 weight (VLBW, birth weight <1500 grams) and 7.4% in extremely low birth weight (ELBW, 55 birth weight <1000 grams) [2]. SIP incidence was related to various perinatal factors, for 56 example, intrauterine drug exposure, especially cocaine, intestinal anomalies (aganglionosis or 57 atresia), congenital heart defects, sepsis, polycythemia, asphyxia, respiratory distress syndrome 

In this case, we reported the premature twin with SIP that was born from Coronavirus-19 68 positive mother. laboratory examination of 1800 g infant shows blood glucose was 70, hematocrit was 51,7%, 88 white blood cell count was 14.8x10 3 /mcL, platelets were 255x10 3 /mcL, sodium 133 mmol/L, 89 potassium 5 mmol/L, calcium 7.2 mg/dL), and albumin 2.9 g/L. A peripheral blood smear was 90 unremarkable. First line antibiotics were given.

The patient was still weak, vomiting was present while feeding, and no defecation was Figure 3A ). Lamina propria and submucosal appear swollen, along with infiltration of 112 inflammatory cells (lymphocytes, histiocytes, plasma cells, and eosinophils) ( Figure 3B ).

Dilatation of blood vessels ( Figure 3C ) and extravasation of erythrocytes ( Figure 3D ) were 114 found. There was no evidence of malignancy found. The conclusion was nonspecific ileitis. birth, earlier than NEC [6] . In this case, perforation occurs two days after delivery with 122 gestational age 32 weeks and birth weight 1800 g, thus belong to SIP.

The aetiology and pathogenesis of SIP were still unknown, and many theories have been 124 proposed, but none has been proven to be the cause [2] . SIP is considered a secondary event to 125 immaturity, postnatal exposure to dexamethasone or indomethacin, hypotension (reflected by the 126 need for inotropes), leukocytosis, candidiasis, staphylococcus epidermidis infection, placement 127 of an umbilical arterial catheter, or the presence of patent ductus arteriosus [1, 7] . Stress, hypoxia, 128 or shock may lead to regional hypoperfusion and transient intestinal ischemia resulting in SIP 

Neonatology: Management, Procedures

On-Call Problem, Diseases, and Drugs