Clinical significance of black-bluish discoloration of the abdominal wall in the newborn

BackgroundThe aim of this study was to evaluate the clinical significance of the newborn with black-bluish discoloration of the abdominal wall (blue abdomen).MethodsBetween December 2007 and November 2016, neonates with blue abdomen referred for the suspicion of spontaneous intestinal perforation (SIP) were retrospectively reviewed. Clinical features and their prognosis were analyzed.ResultsDuring the study period, there were 10 neonates with blue abdomen. Of them, five neonates were proven as having SIP and the others were free of perforation. Enteral feeding was significantly associated with SIP (P = 0.038); however, gestational age, birth weight, gender, the timing of presentation, white blood cell count, platelets count, and the use of indomethacin as well as surfactant therapy were not significantly different between the two groups (P = 0.338, 0.610, 0.490, 0.326, 0.084, 0.741, 0.292, and 0.197, respectively). There was no statistically significant difference in survival between the two groups (P = 0.490).ConclusionsBlack-bluish discoloration of the abdominal wall may be a classical physical finding of SIP, but not be specific to SIP. The factor of enteral feeding might help to establish an appropriate diagnosis before invasive procedures. Because of high mortality, exploratory laparotomy should be avoided if there is no pneumoperitoneum.