{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T01:39:04Z","timestamp":1763429944720,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T00:00:00Z","timestamp":1713830400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Infants presenting with unexpected pneumoperitoneum upon abdominal X-ray, indicating a gastrointestinal perforation (GIP), have a surgical emergency with potential morbidity and mortality. Preoperative determination of the location of perforation is challenging but will aid the surgeon in optimizing the surgical strategy, as colon perforations are more challenging than small bowel perforations. Therefore, the aim of this study is to provide an overview of preoperative patient characteristics, determine the differences between the small bowel and colon, and determine underlying causes in a cohort of infants with unexpected GIP. Methods: All infants (age \u2264 6 months) who presented at our center with unexpected pneumoperitoneum (no signs of pneumatosis before) undergoing surgery between 1996 and 2024 were retrospectively included. The differences between the location of perforation were analyzed using chi-squared and t-tests. Bonferroni correction was used to adjust for multiple tests. Results: In total, 51 infants presented with unexpected pneumoperitoneum at our center, predominantly male (N = 36\/51) and premature (N = 40\/51). Among them, twenty-six had small bowel, twenty-two colon, and three stomach perforations. Prematurity (p = 0.001), birthweight &lt; 1000 g (p = 0.001), respiratory support (p = 0.001), and lower median arterial pH levels (p = 0.001) were more present in patients with small bowel perforation compared with colon perforations. Pneumatosis intestinalis was more present in patients with colon perforation (p = 0.004). All patients with Hirschsprung disease and cystic fibrosis had colon perforation. The final diagnoses were mainly focal intestinal perforations (N = 27\/51) and necrotizing enterocolitis (N = 9\/51). Conclusions: Infants with unexpected GIP, birthweight &lt; 1000 g, and prematurity have more risk for small bowel perforation. In case of colon perforation, additional screening (for Hirschsprung and cystic fibrosis) should be considered.<\/jats:p>","DOI":"10.3390\/children11050505","type":"journal-article","created":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T12:20:30Z","timestamp":1713874830000},"page":"505","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Identifying Preoperative Clinical Characteristics of Unexpected Gastrointestinal Perforation in Infants\u2014A Retrospective Cohort Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4086-7050","authenticated-orcid":false,"given":"Adinda G. H.","family":"Pijpers","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Emma Children\u2019s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, 1105 AZ Amsterdam, The Netherlands"},{"name":"Amsterdam Reproduction & Development Research Institute, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramon R.","family":"Gorter","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Emma Children\u2019s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurens D.","family":"Eeftinck Schattenkerk","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Emma Children\u2019s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joost","family":"van Schuppen","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5494-730X","authenticated-orcid":false,"given":"Chris H. P.","family":"van den Akker","sequence":"additional","affiliation":[{"name":"Amsterdam Reproduction & Development Research Institute, 1105 AZ Amsterdam, The Netherlands"},{"name":"Department of Neonatology, Emma Children\u2019s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvie","family":"Vanhamel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Emma Children\u2019s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernest L. W.","family":"van Heurn","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Emma Children\u2019s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gijsbert D.","family":"Musters","sequence":"additional","affiliation":[{"name":"Department of Surgery, Zaans Medisch Centrum, Koningin Julianaplein 58, 1502 DV Zaandam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joep P. M.","family":"Derikx","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Emma Children\u2019s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"754623","DOI":"10.3389\/fped.2021.754623","article-title":"Development and Validation of a Nomogram for Preoperative Prediction of Localization of Neonatal Gastrointestinal Perforation","volume":"9","author":"Huang","year":"2021","journal-title":"Front. 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Int."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/5\/505\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:32:55Z","timestamp":1760106775000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/5\/505"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,23]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["children11050505"],"URL":"https:\/\/doi.org\/10.3390\/children11050505","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2024,4,23]]}}}