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Dantes G, Murfee J, Doll A, Weaver K, Alemayehu H. Weight at Ostomy Takedown as a Factor to Consider for Operative Timing-Is It Relevant? J Laparoendosc Adv Surg Tech A 2024; 34:855-860. [PMID: 39162564 DOI: 10.1089/lap.2024.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
Purpose: Weight thresholds have historically determined timing of enterostomy closure (EC) in premature neonates. Recent evidence suggests that neonates less than 2 kg (L2K) can safely undergo EC. We evaluate our single-center experience with performing EC in preterm neonates at L2K versus greater than 2 kg (G2K) at time of EC. Methods: A retrospective review of neonates who underwent EC from January 2018 to 2020 was performed. Neonates who were greater than 90 days at initial operation were excluded. Demographics, clinical characteristics including gestational age (GA) and birth weight (BW), operative reports, and outcomes were reviewed. We compared 30-day complications between neonates who underwent EC at L2K and G2K. We also compared time to full feeds (FF) and postoperative length of stay (LOS). Results: Twenty-four neonates were included: 11 L2K and 13 G2K. The median GA and BW was 25.9 weeks (IQR 2.89) and 805 g (IQR 327), respectively. The most common intraoperative diagnosis during index operation was spontaneous perforation (70%), followed by necrotizing enterocolitis (8.69%). There were no significant differences in GA, BW, or diagnosis, between the L2K versus G2K cohort. We found no difference in complication rates, time to FF (12 days versus 10 days, P = .89), or postoperative LOS (31 days versus 36.5 days, P = .76) between patients who underwent EC at L2K versus G2K, respectively. Conclusion: Although weight gain may be an important indicator of perioperative nutrition status, this study shows that weight alone should not preclude otherwise appropriate patients from undergoing EC.
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Affiliation(s)
- Goeto Dantes
- Department of Surgery, Division of Pediatric Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jack Murfee
- Department of Surgery, Division of Pediatric Surgery, University of South Alabama, Mobile, Alabama, USA
| | - Alissa Doll
- Department of Surgery, Division of Pediatric Surgery, University of South Alabama, Mobile, Alabama, USA
| | - Katrina Weaver
- Department of Surgery, Division of Pediatric Surgery, University of South Alabama, Mobile, Alabama, USA
| | - Hanna Alemayehu
- Department of Surgery, Division of Pediatric Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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De Rose DU, Landolfo F, Pugnaloni F, Giliberti P, Santisi A, Columbo C, Martini L, Ronchetti MP, Schingo PM, Salvatori G, Fusaro F, Bagolan P, Dotta A, Capolupo I, Conforti A. Use of N-Acetylcysteine in Preterm Neonates with Enteral Feeding Intolerance and Intestinal Obstruction: A Case Series and Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2024; 11:873. [PMID: 39062322 PMCID: PMC11276329 DOI: 10.3390/children11070873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
(1) Background: The use of N-acetylcysteine (NAC) to relieve meconium obstruction of prematurity in the first days of life has been reported, with NAC reducing the viscosity of luminal contents by cleaving the disulfide bonds of mucoproteins. However, its use in this population should be further explored since it has been associated with hypernatremia and transient increase in transaminases and bilirubin. (2) Methods: In this retrospective study, we included neonates admitted because of enteral feeding intolerance and intestinal obstruction from 2019 to 2021 who received NAC as a rescue therapy before explorative laparotomy. (3) Results: We summarized the clinical presentation of six preterm neonates with enteral feeding intolerance and intestinal obstruction who received NAC as a rescue therapy. Four infants (66.7%) gradually improved without the need for explorative laparotomy, whereas two infants (33.3%) underwent the creation of an ileostomy. No cases of hypernatremia or hepatic derangement associated with NAC therapy were observed. (4) Conclusions: We described the use of NAC treatment by nasogastric tube and/or rectal enemas in preterm infants with enteral feeding intolerance and intestinal obstruction after a multidisciplinary assessment, but the limited sample size did not allow us to obtain definitive conclusions and further research is needed in this field, given the limited evidence about NAC treatment in preterm infants.
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Affiliation(s)
- Domenico Umberto De Rose
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (F.L.); (F.P.); (P.G.); (A.S.); (C.C.); (L.M.); (M.P.R.); (G.S.); (A.D.); (I.C.)
- PhD Course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), Faculty of Medicine and Surgery, “Tor Vergata” University of Rome, 00133 Rome, Italy
| | - Francesca Landolfo
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (F.L.); (F.P.); (P.G.); (A.S.); (C.C.); (L.M.); (M.P.R.); (G.S.); (A.D.); (I.C.)
| | - Flaminia Pugnaloni
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (F.L.); (F.P.); (P.G.); (A.S.); (C.C.); (L.M.); (M.P.R.); (G.S.); (A.D.); (I.C.)
| | - Paola Giliberti
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (F.L.); (F.P.); (P.G.); (A.S.); (C.C.); (L.M.); (M.P.R.); (G.S.); (A.D.); (I.C.)
| | - Alessandra Santisi
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (F.L.); (F.P.); (P.G.); (A.S.); (C.C.); (L.M.); (M.P.R.); (G.S.); (A.D.); (I.C.)
| | - Claudia Columbo
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (F.L.); (F.P.); (P.G.); (A.S.); (C.C.); (L.M.); (M.P.R.); (G.S.); (A.D.); (I.C.)
| | - Ludovica Martini
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (F.L.); (F.P.); (P.G.); (A.S.); (C.C.); (L.M.); (M.P.R.); (G.S.); (A.D.); (I.C.)
| | - Maria Paola Ronchetti
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (F.L.); (F.P.); (P.G.); (A.S.); (C.C.); (L.M.); (M.P.R.); (G.S.); (A.D.); (I.C.)
| | - Paolo Maria Schingo
- Emergency Imaging Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy;
| | - Guglielmo Salvatori
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (F.L.); (F.P.); (P.G.); (A.S.); (C.C.); (L.M.); (M.P.R.); (G.S.); (A.D.); (I.C.)
| | - Fabio Fusaro
- Neonatal Surgery Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (F.F.); (P.B.); (A.C.)
| | - Pietro Bagolan
- Neonatal Surgery Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (F.F.); (P.B.); (A.C.)
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00165 Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (F.L.); (F.P.); (P.G.); (A.S.); (C.C.); (L.M.); (M.P.R.); (G.S.); (A.D.); (I.C.)
| | - Irma Capolupo
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (F.L.); (F.P.); (P.G.); (A.S.); (C.C.); (L.M.); (M.P.R.); (G.S.); (A.D.); (I.C.)
| | - Andrea Conforti
- Neonatal Surgery Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (F.F.); (P.B.); (A.C.)
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Petit AL, Alwan R, Behr J, Calame P, Lenoir M, Ducou le Pointe H, Delabrousse É. Dose optimization in newborn abdominal radiography: Assessing the added value of additional filtration on radiation dose and image quality using an anthropomorphic phantom. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2024; 10:100045. [PMID: 39077732 PMCID: PMC11265153 DOI: 10.1016/j.redii.2024.100045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/01/2024] [Indexed: 07/31/2024]
Abstract
Background Abdominal radiographs remain useful in newborns. Given the high radiation sensitivity of this population, it is necessary to optimize acquisition techniques to minimize radiation exposure. Objective Evaluate the effects of three additional filtrations on radiation dose and image quality in abdominal X-rays of newborns using an anthropomorphic phantom. Material and method Abdominal radiographs of an anthropomorphic newborn phantom were performed using acquisition parameters ranging from 55 to 70 kV and from 0.4 to 2.5 mAs, without and with three different additional filtrations: 0.1 mm copper (Cu) + 1 mm aluminum (Al), 0.2 mm copper + 1 mm aluminum, and 2 mm aluminum. For each X-ray the dose area product (DAP) was measured, the signal-to-noise ratio (SNR) was calculated, and image quality (IQ) was evaluated by two blinded radiologists using the absolute visual grading analysis (VGA) method. Results Adding an additional filtration resulted in a significant reduction in DAP, with a decrease of 42% using 2 mm Al filtration, 65% with 0.1 mm Cu + 1 mm Al filtration, and 78% with 0.2 mm Cu + 1 mm Al filtration (p < 0.01). The addition of 2 mm aluminum filtration does not significantly decrease the SNR (p = 0.31), CNR (p = 0.52) or the IQ (p = 0.12 and 0.401 for reader 1 and 2, respectively). However, adding copper-containing filtration leads to a significant decrease in, SNR, CNR and IQ. Conclusion Adding a 2 mm Al additional filtration for abdominal radiographs in newborns can significantly reduce the radiation dose without causing a significant decrease in image quality.
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Affiliation(s)
| | - Rabih Alwan
- Department of Radiology, hôpital Jean-Minjoz, Besançon, France
| | - Julien Behr
- Department of Radiology, hôpital Jean-Minjoz, Besançon, France
| | - Paul Calame
- Department of Radiology, hôpital Jean-Minjoz, Besançon, France
| | - Marion Lenoir
- Department of Radiology, hôpital Jean-Minjoz, Besançon, France
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Kostekci YE, Ocak BO, Ekiyor E, Gucenmez K, Demirtas F, Ergun E, Mehdilli A, Bahadir GG, Okulu E, Erdeve Ö, Arsan S, Atasay B. Acute Abdomen in an Extremely Low-Birth-Weight Preterm Neonate: A Case of Appendicitis. Z Geburtshilfe Neonatol 2023; 227:307-309. [PMID: 37224881 DOI: 10.1055/a-2044-0889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Neonatal appendicitis is a very rare surgical entity. Non-specific symptoms such as feeding intolerance, abdominal distension, vomiting, increased gastric residue, lethargy, and fever may be present. The majority of reported cases could not be identified early. In this report, we present an extremely low-birth-weight preterm neonate who has been diagnosed with appendicitis. CASE PRESENTATION A 980-gram preterm baby girl was born at 31 1/7 weeks of gestation. The physical examination was normal at birth. Her initial clinical course was uneventful. On the 7th day of life, she developed abdominal distention and tenderness. She had an episode of bloody stools and bilious vomiting. An abdominal X-ray suggested localized perforation in the cecum with an air-fluid level in the right lower quadrant. The clinical findings suggested necrotizing enterocolitis and perforation, and a diagnostic laparotomy was performed. The bowel was found to be normal with a necrotic appendix. The appendectomy was performed. She was discharged from the neonatal intensive care unit with no complications. CONCLUSION Appendicitis is extremely rare in the neonatal period. It is quite challenging to evaluate the presentation accurately, which causes a delay in diagnosis. However, if an atypical NEC or peritonitis is present, appendicitis should be considered. Early diagnosis and timely surgical intervention improve the prognosis of neonatal appendicitis.
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Affiliation(s)
- Yasemin Ezgi Kostekci
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Buse Onen Ocak
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ege Ekiyor
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Kader Gucenmez
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ferhan Demirtas
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ergun Ergun
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aysel Mehdilli
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gulnur Gollu Bahadir
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emel Okulu
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ömer Erdeve
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Saadet Arsan
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Begum Atasay
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
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Nguyen TX, Dang NT, Phan HT, Pham NH, Vu HA. Perforated Acute Appendicitis in a Six-Day-Old Neonate: A Rare Differential Diagnosis of Neonatal Peritonitis. Case Rep Gastroenterol 2021; 15:188-194. [PMID: 33790704 PMCID: PMC7989800 DOI: 10.1159/000512425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/16/2020] [Indexed: 12/02/2022] Open
Abstract
Acute appendicitis is a rare diagnosis of acute abdomen in neonates which is associated with high mortality due to late diagnosis. Here, we presented a case of acute neonatal appendicitis in a 6-year-old full-term infant with Down syndrome and pulmonary atresia with ventricular septal defect. The patient underwent surgery and postoperative critical care. However, he died on postoperative day 5 due to worsening sepsis and decompensated hemodynamic instability.
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Affiliation(s)
- Thanh Xuan Nguyen
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue City, Vietnam
| | - Nhu Thanh Dang
- Surgery Department, Hue University of Medicine and Pharmacy, Hue City, Vietnam
| | - Hai Thanh Phan
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue City, Vietnam
| | - Nhu Hien Pham
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue City, Vietnam
| | - Hoai Anh Vu
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue City, Vietnam
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Fetal Midgut Volvulus with Meconium Peritonitis Detected on Prenatal Ultrasound. Case Rep Obstet Gynecol 2018; 2018:5312179. [PMID: 29854513 PMCID: PMC5960549 DOI: 10.1155/2018/5312179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/26/2018] [Indexed: 11/22/2022] Open
Abstract
Background Fetal volvulus is a rare, yet life-threatening condition that requires skilful diagnosis and management. Volvulus occurs when bowel loops become twisted and the twisting of the mesenteric artery leads to congestion, impaired venous return, and bowel necrosis. Case Description We present a case of fetal ileal volvulus suspected on third trimester ultrasound, complicated by premature labour, small bowel necrosis, and meconium peritonitis. Progressive dilatation and decreased peristalsis of echogenic bowel were noted in the early part of the third trimester. Daily surveillance ultrasound was performed and spontaneous labour occurred at 32 weeks' gestation. A proactive postnatal approach guided by prenatal sonographic findings allowed prompt treatment and an urgent laparotomy was performed for an ileal volvulus with necrosis and meconium peritonitis. A segment of small bowel volvulus was resected and an end-to-end anastomosis was performed with uneventful recovery. Discussion Clinically signs of fetal midgut volvulus are not pathognomonic, such as intestinal dilatation, abdominal mass, ascites, peritoneal calcifications, or polyhydramnios; thus, the diagnosis is often challenging. Complications reported in the literature include perforation and haemorrhagic ascites, which may lead to anaemia, hypovolemia, heart failure, and fetal demise. Conclusion This case highlights the importance of assessing the fetal bowel as a part of routine third trimester ultrasound. The case describes the complexity of diagnosis in the fetus, important considerations along with multidisciplinary team approach to management.
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Kylat RI. Internal Hernia Masquerading As Necrotizing Enterocolitis. Front Pediatr 2017; 5:225. [PMID: 29164078 PMCID: PMC5671485 DOI: 10.3389/fped.2017.00225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/05/2017] [Indexed: 11/30/2022] Open
Abstract
In extremely preterm infants, acute abdominal emergencies are fortunately less common with improving care. Spontaneous intestinal perforation and necrotizing enterocolitis are conditions where emergency surgery is most often needed. Conservative medical management and placement of temporary drain are often used in the initial management. Internal hernia (IH) is an uncommon cause of bowel obstruction in neonates, is difficult to diagnose and unfortunately are found only at autopsy. The presentation in preterm infants, distinction between these conditions, and the need for early diagnosis of IH are discussed.
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Affiliation(s)
- Ranjit I Kylat
- Department of Pediatrics, College of Medicine, University of Arizona, Tucson, AZ, United States
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Abstract
Introduction.The surgical treatment of the acute neonatal abdomen still poses a challenge in pediatric surgery. Various underlying etiologies require different surgical procedures. Until today the role of laparoscopy in the surgical treatment of the acute neonatal abdomen is controversial. The aim of this study was to analyze our experiences with laparoscopy and to perform a review of the literature. Methods. Retrospective, single-institution study including all term and preterm neonates initially undergoing laparoscopy due to an acute abdomen. Results. Altogether, 17 neonates presenting with an acute neonatal abdomen initially underwent laparoscopy. Unnecessary laparotomy could be avoided in 9 of 17 (53%) neonates. After diagnostic laparoscopy, 2 patients did not require any further surgical intervention. Eight neonates presented midgut atresia intraoperatively, 5 of them underwent laparoscopic-assisted correction. Successful laparoscopic derotation of an acute volvulus (n = 1) and laparoscopic appendectomy (n = 1) could be performed. Conversion to open surgery was necessary in 8 neonates (47%) due to creation of a stoma (n = 5), multiple intestinal bands causing poor visualization (n = 2), and bowel necrosis (n = 1). Conclusions. Laparoscopy is a useful diagnostic tool to evaluate the need for further surgical intervention in the acute neonatal abdomen and enables immediate surgical treatment of acute volvulus, appendicitis, or intestinal atresia. In case of conversion to laparotomy, precise localization of the incision is guaranteed. Minimization of the surgical trauma and avoidance of unnecessary laparotomy are the most important benefits of the minimal-invasive approach for the critically ill neonate.
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Lee J, Kang MJ, Kim HS, Shin SH, Kim HY, Kim EK, Choi JH. Enterostomy closure timing for minimizing postoperative complications in premature infants. Pediatr Neonatol 2014; 55:363-8. [PMID: 24582165 DOI: 10.1016/j.pedneo.2014.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/23/2013] [Accepted: 01/18/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND For premature infants with advanced acute abdomen, creating a temporary enterostomy is believed to be an appropriate surgical management. However, there is no consensus regarding the timing of enterostomy reversal. The aim of this study was to determine the optimal timing for enterostomy closure (EC) by analyzing EC-related complications. METHODS This was a retrospective study of preterm infants who underwent enterostomy for suspected acute abdomens and subsequent closure. RESULTS EC-related complications occurred in 35 of 54 infants (65%). A univariate analysis determined the following risk factors for EC-related complications: lower weight and younger age at the time of EC and a shorter stoma duration. In a multiple logistic regression analysis, the only significant risk factor was a weight under 2660 g at the time of the closure operation. Infants with EC-related complications were ventilated longer, were administered more vasopressors, and were more likely to undergo reoperation. Additionally, these infants required parenteral nutrition for a longer duration, had a longer length of hospital stay after EC, and had a significantly lower weight and height at a corrected age of 7-10 months than infants without EC-related complications. CONCLUSION Body weight may be one of the most important factors to consider for minimizing EC-related complications.
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Affiliation(s)
- Juyoung Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min-Jung Kang
- Department of Medical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Seung-Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
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Patel RV, Kumar H, Sinha CK, Patricolo M. Neonatal prolapsed patent vitellointestinal duct. BMJ Case Rep 2013; 2013:bcr-2013-010221. [PMID: 23845681 PMCID: PMC3736227 DOI: 10.1136/bcr-2013-010221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A case of a prolapsed patent vitellointestinal duct (PVID) in a 10-day-old neonate who presented with vomiting and poor weight gain with partial intestinal obstruction and a flower like pink, prolapsing lesion at his umbilicus has been reported. A limited contrast study through the tubular structure confirmed it to be a PVID. He underwent transumbilical exploration and resection and anastomosis uneventfully. Persistence of the vitellointestinal duct as a whole or part of it leads to a wide variety of anomalies-Meckel's diverticulum is the commonest lesion and a PVID is the rarest. Umbilical cord clamping flush with the abdominal wall may convert a Meckel's diverticulum prolapsing in the base of umbilical ring into a PVID. Careful assessment should be made for associated anomalies. Transumbilical exploration gives the best cosmetic and functional results.
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Affiliation(s)
- Ramnik V Patel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK.
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12
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Schurr P, Perkins EM. The relationship between feeding and necrotizing enterocolitis in very low birth weight infants. Neonatal Netw 2009; 27:397-407. [PMID: 19065969 DOI: 10.1891/0730-0832.27.6.397] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the NICU, with often devastating consequences. The etiology of NEC is probably multifactorial, with preterm infants at the highest risk. The relationship between feeding and NEC was identified in the 1970s, leading to delayed feeding becoming standard treatment in NICUs. More recent research suggests that early feedings not only are safe, but reduce other morbidities associated with prematurity. Standardized feeding guidelines seem to confer some benefits in decreasing NEC, despite a wide variability in feeding practices within the published guidelines. A standardized approach to the management of feeding problems may be the key. This article briefly reviews the pathogenesis of NEC and examines studies of various feeding practices for their relationship to the development of NEC. It also highlights the potential benefits of breast milk in NEC prevention.
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Affiliation(s)
- Patti Schurr
- NICU, Sunnybrook Health Science Centre, Women College, Toronto, Ontario, Canada.
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Ekenze SO, Ibeziako SN, Ezomike UO. Trends in neonatal intestinal obstruction in a developing country, 1996-2005. World J Surg 2007; 31:2405-9; discussion 2410-1. [PMID: 17763898 DOI: 10.1007/s00268-007-9206-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 06/23/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the advances in neonatal surgery, the outcome of neonatal intestinal obstruction (NIO) in many developing countries has been reported to be poor. This study describes the trends in NIO, including the contributory factors in southeast Nigeria. METHODS We performed a comparative analysis of 128 consecutive NIO managed from January 1996 to December 2005 at the University of Nigeria Teaching Hospital, Enugu, in southeast Nigeria. RESULTS Fifty-five (43.0%) neonates were managed in the first 5 years (group A) and 73 (57.0%) in the last 5 years (group B). Etiology of obstruction did not vary significantly in the two groups. Average duration of symptoms before presentation fell from 5.9 days (group A) to 4.7 days (group B). With exception of Hirschsprung's disease (HD), all other cases required operative treatment. In HD, colostomy rate declined from 44.4% (group A) to 26.7% (group B). More neonates in group B were managed with general anesthesia and perioperative third-generation cephalosporin antibiotics (p < 0.01). While complication rate did not vary significantly in the two groups (group A, 42%; group B, 40.3%), survival improved (group A, 61.8%; group B, 72.6%). Earlier presentation, improved manpower, and use of potent antibiotics may have contributed to the improved outcome. Challenges in the form of lack of neonatal intensive care facilities and dearth of qualified personnel persist. CONCLUSION There is a trend toward earlier presentation and increased survival of babies with NIO in our setting. Improving the existing facilities and trained manpower, and establishing collaboration with centers that have excellent results may further encourage the trend.
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Affiliation(s)
- S O Ekenze
- Subdepartment of Paediatric Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
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