Proceedings: Neonatal peritonitis.

Neonatal peritonitis remains a dangerous condition. Factors complicating diagnosis and management include 
its low incidence, the diversity of aetiological factors found, and the 
severity of underlying or associated disease. 28 cases presenting since 1957 
at Southmead General Hospital were reviewed. Thirteen aetiological factors relating to 
mother or baby were found. 13 infants were premature, 10 had 
severe respiratory problems at birth. Maternal hydramnios was present in 7. 
6 babies had had exchange transfusion. The commonest findings were gangrenous 
volvulus and cystic fibrosis. Combined factors were often present. The usual 
presentation is with bilious vomiting, abdominal distension, and failure to pass 
normal meconium. 4 cases had distended abdomens at birth. Plain abdominal 
x-rays are of great diagnostic value. Pneumoperitoneum is diagnostic but absent 
from early films. Treatment is surgical. Close liaison with the paediatrician 
who sees the baby first is essential. In assessing results it 
is pointed out that many of these babies are small and/or 
suffering from serious conditions such as haemolytic disease, cystic fibrosis, or 
gangrenous volvulus. 8 cases were considered unfit for surgery. Of 20 
submitted to surgery, 12 survived, mostly in the latter part of 
the series. 