Spontaneous intestinal perforation (SIP) and necrotizing enterocolitis (NEC) are the reason of intestinal damage in preterm neonates with low and extremely low body weight. Etiology of SIP is still unknown. It has not been determined whether SIP is a separate disease entity or only benign form of necrotizing enterocolitis (NEC). Surgical treatment includes peritoneal drainage, resection and primary intestinal anastomosis or temporary ileostomy.The aim of the study was to estimate risk factors and the strategy of surgical treatment in SIP.Material and methods. Between 2006 and 2008 ten patients undergone surgery for SIP. Retrospective analysis of patients' data was performed.Results. Mean gestational age was 26.1±3,143 Hbd, mean body weight 892±113.3 g. Sudden deterioration in the general condition with distension and lividity of the abdomen was correlated with radio-logical findings of perforation in all patients. Peritoneal drainage was performed in one patient, in one patient primary anastomosis was performed and multistages surgical treatment was done in the remaining. In resected segments of the intestine the histological signs of SIP were present. Two patients died, the follow-up of the remaining was maintaining for 4-24 months.Conclusions. Definitive differentiation between SIP and NEC can be made only by intraoperative view and histological evaluation of resected intestine. Survival rate (80%) in the study group was correlated with individual surgical strategy and advances in neonatal care.