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Research Article |

Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features

Objective: To evaluate outcome and survival rate we focused on the severity of necrotizing enterocolitis without (NEC) or with perforation (NECp) and spontaneous intestinal perforation (SIP) and their influence on clinical deterioration and surgical complications. Methods: Aim was to compare the clinical features, radiographic findings and outcome of SIP, NEC and NECp. Focus was on a potential risk profile and 76 preterm were included. Results: Symptoms started earlier in SIP (p < 0.001). Systemic signs were led by body temperature instability (p = 0.014), hypotension (p = 0.022), manifested sepsis (p = 0.011), septic shock (p = 0,010) and disseminated intravascular coagulation (p = 0.021). The Bell classification was suitable for staging NEC (p < 0.001) and indication for laparotomy (p < 0.001), but postinterventional 17% has to be upgraded to stage IIIb (p < 0.001). Abdominal distension (p = 0.003) and -resistance (p = 0.033) were significantly more often found in NEC, while bloody stool (p = 0.035), oedematous abdominal wall (p = 0.044) and abdominal skin discoloration (p < 0.001) were typical for NECp or SIP, like an abdominal wall erythema (p = 0.049) for NECp. Radiographically signs like pneumatizes intestinalis (p < 0.001), bowel dilatation (p = 0.012) and thickened intestinal walls (p < 0.001) were less present in SIP, contrary to a pneumoperitoneum (p < 0.001), but survival rate did not differ. Conclusion: BELL classification is suitable for assigning NEC, but the degree of severity was underestimated in 17% of preterm. Focus should be on sick preterm with a coagulation disorder/ DIC, after resuscitation, glucose utilization disorder, septic shock or manifested sepsis. Intubation or high frequency ventilation were additionally risking for NECp followed by higher mortality rate.

Neonatology, Nec, Bell Classification, Survival, Outcome

APA Style

Kapapa, M., Hahne, J., Serra, A. (2023). Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features. American Journal of Pediatrics, 9(4), 210-216.

ACS Style

Kapapa, M.; Hahne, J.; Serra, A. Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features. Am. J. Pediatr. 2023, 9(4), 210-216. doi: 10.11648/j.ajp.20230904.14

AMA Style

Kapapa M, Hahne J, Serra A. Bowel Perforation in Preterm: Predictive Power of Bell Classification and Clinical Features. Am J Pediatr. 2023;9(4):210-216. doi: 10.11648/j.ajp.20230904.14

Copyright © 2023 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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