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Itoshima R, Oda A, Ogawa R, Yanagisawa T, Hiroma T, Nakamura T. Respiratory and Gastrointestinal Management of an Infant with a Birth Weight of 258 Grams. AJP Rep 2022; 12:e89-e95. [PMID: 35154903 PMCID: PMC8828450 DOI: 10.1055/a-1678-3755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022] Open
Abstract
Today, more infants weighing less than or equal to 300 g are born, and they survive because of the improvements in neonatal care and treatment. However, their detailed clinical course and neonatal intensive care unit management remain unknown due to their low survival rate and dearth of reports. A male infant was born at 24 weeks and 5 days of gestation and weighed 258 g. The infant received 72 days of invasive and 92 days of noninvasive respiratory support, including high-frequency oscillatory ventilation with volume guarantee and noninvasive neurally adjusted ventilatory assist. Meconium-related ileus was safely treated using diatrizoate. Although the infant was diagnosed with severe bronchopulmonary dysplasia and retinopathy of prematurity requiring laser photocoagulation, he had no other severe complications. He was discharged 201 days postdelivery (3 months of corrected age) with a weight of 3.396 kg. Although managing infants weighing less than or equal to 300 g is difficult, our experience shows that it is possible by combining traditional and modern management methods. The management of such infants requires an understanding of the expected difficulties and adaptation of existing methods to their management. The management techniques described here should help improve their survival and long-term prognosis.
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Affiliation(s)
- Ryo Itoshima
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan.,Department of Pediatrics, University of Turku, Turku, Finland
| | - Arata Oda
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan
| | - Ryo Ogawa
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan
| | | | - Takehiko Hiroma
- Division of Neonatology, Nagano Children's Hospital, Nagano, Japan
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Till H, Singer G, Castellani C, Urlesberger B. Loop Ileostomy in Europe's Tiniest Male Newborn for Meconium-Related Ileus. European J Pediatr Surg Rep 2021; 9:e17-e19. [PMID: 33680707 PMCID: PMC7929717 DOI: 10.1055/s-0040-1721406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/24/2020] [Indexed: 10/31/2022] Open
Abstract
With the advances of neonatology, the survival rate for "live-born periviable fetuses" weighing < 300 g, a subgroup of extremely low birth weight (BW) infants, has improved over the past 10 years. Meconium-related ileus (MRI) represents an early postnatal hazard, and, if medical evacuation fails, a surgical challenge in such immature babies. We report the interdisciplinary management of surgically treated MRI in a newborn with a BW of 273 g. According to the worldwide database held by the University of Iowa, he is registered as the tiniest male newborn in Europe. The boy was born in the 25th gestational week by cesarean section after a triplet pregnancy with twin-twin transfusion syndrome, him being the donor. He had a BW of 273 g, whereas his brothers had a BW of 740 g and 722 g. Cardiopulmonary stabilization and ventilation were successful. He developed MRI unresponsive to medical treatment. On day 14 of life, a minilaparotomy was performed in the right lower quadrant to externalize a loop of the distal ileum in a no-touch technique. Despite the small diameter of only 2 mm, a standard loop ileostomy could be fashioned. There were no intra- or postoperative abdominal complications. Bowel function and weight gain were adequate and the ileostomy was closed electively 5 months later at a body weight of 3.5 kg. In summary, minilaparotomy and loop ileostomy placement were effective to treat surgical MRI in Europe's tiniest male newborn. With the advances of neonatology, pediatric surgery reaches new frontiers as well.
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Affiliation(s)
- Holger Till
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Georg Singer
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Christoph Castellani
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Department of Paediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Graz, Graz, Austria
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Yokoyama S, Nakaoka T, Nukada T, Ikeda Y, Hara S. Meconium-related ileus mimicking ileal atresia in a full-term neonate. Pediatr Int 2021; 63:229-231. [PMID: 33529482 DOI: 10.1111/ped.14531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/27/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Satoshi Yokoyama
- Department of Pediatric Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Tatsuo Nakaoka
- Department of Pediatric Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Takayuki Nukada
- Department of Pediatrics, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Yuka Ikeda
- Department of Pediatrics, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Shigeto Hara
- Department of Pediatrics, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
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Michikata K, Kodama Y, Kaneko M, Sameshima H, Ikenoue T, Machigashira S, Mukai M, Torikai M, Nakame K. Oral diatrizoate acid for meconium-related ileus in extremely preterm infants. Pediatr Int 2018; 60:714-718. [PMID: 29804321 DOI: 10.1111/ped.13606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 05/13/2018] [Accepted: 05/24/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intestinal disorders are common in very low-birthweight infants. The purpose of this study was to evaluate the impact of prophylactic oral Gastrografin® (diatrizoate acid) on meconium-related ileus (MRI) in extremely preterm infants. METHODS This was a retrospective case-control study of infants born extremely preterm at <28 weeks of gestation and treated with diatrizoate acid (prophylactic group) or not (control group) in the periods 2007-2014 and 2000-2009, respectively. In the 2007-2014 period, 120 infants received prophylactic diatrizoate acid solution. From the 165 infants in the control group, we selected 120 infants matched for gestational age. Cases of death before 72 h of life or congenital abnormalities were excluded. Intestinal disorders, time until full enteral feeding, duration of hospital stay, mortality rate, and neurodevelopmental outcome were compared. RESULTS MRI occurred in six infants in the control group and in none of the infants in the prophylactic group (P = 0.039). Median time until full enteral feeding was 25 versus 22 days (P < 0.01), hospital stay was 142 versus 126 days (P < 0.01), and mortality rate for infants aged 24-27 weeks was 8.2% versus 0% (P = 0.021), respectively. CONCLUSIONS Prophylactic oral diatrizoate acid reduced MRI in extremely preterm infants without side-effects and decreased the mortality rate of infants born at 24-27 weeks, and is thus beneficial in extremely preterm infants.
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Affiliation(s)
- Kaori Michikata
- Department of Obstetrics and Gynecology, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Yuki Kodama
- Department of Obstetrics and Gynecology, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Masatoki Kaneko
- Department of Obstetrics and Gynecology, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Hiroshi Sameshima
- Department of Obstetrics and Gynecology, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Tsuyomu Ikenoue
- Department of Obstetrics and Gynecology, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Seiro Machigashira
- Department of Pediatric Surgery, Kagoshima University, Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
| | - Motoi Mukai
- Department of Pediatric Surgery, Kagoshima University, Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
| | - Motofumi Torikai
- Department of Pediatric Surgery, Kagoshima University, Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
| | - Kazuhiko Nakame
- Department of Pediatric Surgery, Kagoshima University, Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
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Okuyama H, Ohfuji S, Hayakawa M, Urushihara N, Yokoi A, Take H, Shiraishi J, Fujinaga H, Ohashi K, Minagawa K, Misaki M, Nose S, Taguchi T. Risk factors for surgical intestinal disorders in VLBW infants: Case-control study. Pediatr Int 2016; 58:34-9. [PMID: 26333186 DOI: 10.1111/ped.12815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 02/20/2015] [Accepted: 06/10/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Very low-birthweight (VLBW) infants (VLBWI) are at increased risk for surgical intestinal disorders including necrotizing enterocolitis (NEC), focal intestinal perforation (FIP) and meconium-related ileus (MRI). The aim of this study was to identify disease-specific risk factors for surgical intestinal disorders in VLBWI. METHODS A retrospective multicenter case-control study was conducted at 11 institutes. We reviewed VLBWI who underwent laparotomy for intestinal disorders including perforation and intractable bowel obstruction. The surgical disorders were classified into four categories (NEC, FIP, MRI, others) based on the macroscopic findings at operation. In order to identify risk factors, two matched controls for each subject were chosen based on gestational age and birthweight. OR and 95%CI were calculated using a conditional logistic regression model and a multivariate model. RESULTS A total of 150 cases (NEC, n = 44; FIP, n = 47; MRI, n = 42; others, n = 17) and 293 controls were identified. The cases and controls were similar in terms of gestational age and birthweight (cases/controls, 26.7 ± 2.5/26.5 ± 2.6 weeks; 790 ± 256/795 ± 257 g). On multivariate modeling, disease-specific risk factors were as follows: female (OR, 0.23; 95%CI: 0.06-0.89), respiratory distress syndrome (OR, 35.7; 95%CI: 2.48-514) and patent ductus arteriosus (OR, 10.9; 95%CI: 1.51-79.3) for NEC; outborn delivery (OR, 5.47; 95%CI: 1.48-20.2) for FIP; and twin pregnancy (OR, 4.25; 95%CI: 1.06-17.1), PROM (OR, 6.85; 95%CI: 1.33-35.4) and maternal steroid (OR, 0.23; 95%CI: 0.07-0.79) for MRI. CONCLUSIONS Different risk factors were identified for NEC, FIP and MRI, suggesting that each disease has a different etiology, and that different strategies are required to prevent these diseases.
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Affiliation(s)
- Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Satoko Ohfuji
- Department of Public Health, Faculty of Medicine, Osaka City University, Osaka, Japan
| | - Masahiro Hayakawa
- Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Akiko Yokoi
- Department of Pediatric Surgery, Hyogo Children's Hospital, Kobe, Japan
| | - Hiroshi Take
- Department of Pediatric Surgery, Kanagawa Children's Hospital, Yokohama, Japan
| | - Jun Shiraishi
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | - Hideshi Fujinaga
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Ohashi
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Kyoko Minagawa
- Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Maiko Misaki
- Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Satoko Nose
- Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan
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Hayakawa M, Taguchi T, Urushihara N, Yokoi A, Take H, Shiraishi J, Fujinaga H, Ohashi K, Oshiro M, Kato Y, Ohfuji S, Okuyama H. Outcome in VLBW infants with surgical intestinal disorder at 18 months of corrected age. Pediatr Int 2015; 57:633-8. [PMID: 25639880 DOI: 10.1111/ped.12594] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 12/27/2014] [Accepted: 01/19/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical intestinal disorders, such as necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI), are serious morbidities in very low-birthweight infants (VLBWI). The aim of this study was to compare the composite outcomes of death or neurodevelopmental impairment (NDI) in VLBWI with surgical intestinal disorders and assess independent risk factors for death and NDI at 18 months of corrected age. METHODS A retrospective matched-cohort study was conducted at 11 institutes. We included VLBWI who had undergone laparotomy for NEC, FIP, and MRI. Two control subjects were chosen for every surgical patient and matched for gestational age and birthweight to form the comparison group. Death and neurodevelopmental outcome at 18 months of corrected age were evaluated. RESULTS The number of infants in the NEC, FIP, MRI, and control groups was 44, 47, 42, and 261, respectively. In-hospital mortality was higher in infants with NEC and MRI relative to those in the control group (P < 0.001). The incidence rate for NDI at 18 months of corrected age was higher in infants with MRI relative to those in the control group (P = 0.021). On logistic regression analysis, low gestational age, male sex, small for gestational age, intraventricular hemorrhage, and MRI were associated with increased risk of death or NDI at 18 months of corrected age. CONCLUSIONS NEC and MRI were associated with in-hospital mortality, and MRI was associated with NDI or death at 18 months of corrected age.
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Affiliation(s)
- Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Akiko Yokoi
- Department of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Hiroshi Take
- Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Jun Shiraishi
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Tokyo, Japan
| | - Hideshi Fujinaga
- Division of Neonatology, Center for Maternal-Fetal and Neonatal Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Ohashi
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Oshiro
- Department of Neonatology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Yuichi Kato
- Department of Pediatrics, Anjo Kosei Hospital, Anjo, Japan
| | - Satoko Ohfuji
- Department of Public Health, Osaka City University Faculty of Medicine, Osaka, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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