Association of Over-the-Counter Nospamin and Gripe Water Use with Spontaneous Intestinal Perforation in Neonates: A Case Series

Abstract

Introduction: Spontaneous intestinal perforation in newborns, often seen in the terminal ileum, is linked to risk factors such as prematurity, low birth weight, and drug exposure. Over-the-counter use of medications like Nospamin (an anticholinergic) and gripe water (an herbal supplement) for infantile colic is common, especially in developing countries, raising concerns about their potential role in gastrointestinal complications.

Methods: This retrospective case series describes five neonates presenting with intestinal perforation following exposure to Nospamin and/or gripe water. All cases were managed at the University of Ilorin Teaching Hospital over a 12-month period. Clinical assessment, blood work, imaging, and, when indicated, exploratory laparotomy were performed. Interventions included resuscitation, nasogastric decompression, and, where necessary, surgical repair.

Results: The neonates, with an average age of 8.4 days at presentation, showed abdominal distension, fever, and feeding refusal. Imaging confirmed intestinal perforation in all cases. Three neonates underwent successful perforation repair; one neonate improved with conservative management, while another succumbed to hepatic failure and multiple organ dysfunction syndrome. The observed link between Nospamin/gripe water exposure and perforation onset warrants further investigation.

Discussion: The cases suggest a possible association between self-medication with Nospamin and gripe water and neonatal intestinal perforation. These findings highlight the need for public education on the risks of unsupervised medication use in neonates. Increased regulatory oversight and awareness campaigns are essential to reduce self-medication practices in vulnerable populations and improve neonatal outcomes.