Is Early and Recurrent Anemia in a Preterm Infant a Risk Factor for Neonatal Appendicitis?

BACKGROUND

Neonatal appendicitis (NA) is a rare condition with an estimated incidence of 0.04% to 0.2%. It is more prevalent in male preterm infants, with a mortality rate of 20% to 25%. It is usually misdiagnosed as neonatal necrotizing enterocolitis (NEC) owing to its diverse diagnostic challenges. Poor perfusion, hypoxia, anemia, or any other condition that impairs intestinal blood supply is a risk factor for bowel injury, which could explain the physiopathology of NA.

CLINICAL FINDINGS: We describe an interesting case of a preterm infant with recurrent episodes of abdominal distension and persistent anemia who was finally diagnosed with NA.

PRIMARY DIAGNOSIS: The patient was treated with exploratory laparotomy and appendicectomy, with further symptom resolution. The diagnosis was confirmed by pathological examination.

INTERVENTIONS: Surgery for acute abdomen secondary to perforated appendicitis.

OUTCOMES: Improved recurrent abdominal distension and persistent anemia and achieved full enteral nutrition. Patients with other diseases such as Hirschsprung's disease were ruled out.

PRACTICE RECOMMENDATIONS: This case demonstrates that identifying the early signs and symptoms of NA requires a high index of suspicion. Anemia may play a significant role in the etiology of intestinal injury, increasing the risk of NA and NEC. Further studies are needed to explore the association between anemia and intestinal injury and its implications for neurodevelopment.