J Korean Med Sci.  2019 Sep;34(35):e222. 10.3346/jkms.2019.34.e222.

Comparison of Acute Abdominal Surgical Outcomes of Extremely-Low-Birth-Weight Neonates according to Differential Diagnosis

Affiliations
  • 1Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea. spkhy02@snu.ac.kr
  • 2Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND
Improvements in perinatal intensive care have improved survival of extremely-low-birth-weight (ELBW) neonates, although the risk of acute abdomen has increased. The differential diagnosis resulting in abdominal surgery can be categorized into necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP), meconium-related ileus (MRI), and meconium non-related ileus (MNRI). The purpose of this study was to review our experience with abdominal surgery for ELBW neonates, and to evaluate characteristics and prognosis according to the differential diagnosis.
METHODS
Medical records of ELBW neonates treated between 2003 and 2015 were retrospectively reviewed.
RESULTS
Of 805 ELBW neonates, 65 (8.1%) received abdominal surgery. The numbers of cases by disease category were 29 for NEC, 18 for SIP, 13 for MRI, and 5 for MNRI. Ostoma formation was performed in 61 (93.8%) patients; primary anastomosis without ostoma was performed in 4 (6.2%). All patients without ostoma formation experienced re-perforation of the anastomosis site. Seven patients had 30-day postoperative mortality (6 had NEC). Long-term survival of the surgical and non-surgical groups was not statistically different. NEC was a poor prognostic factor for survival outcome (P = 0.033).
CONCLUSION
Abdominal surgery for ELBW neonates is feasible. Ostoma formation can lead to reduced complications compared to primary anastomosis.

Keyword

Extremely Low Birth Weight; Necrotizing Enterocolitis; Spontaneous Intestinal Perforation; Meconium Related Ileus; Meconium Non-Related Ileus; Abdominal Surgery

MeSH Terms

Abdomen, Acute
Critical Care
Diagnosis, Differential*
Enterocolitis, Necrotizing
Humans
Ileus
Infant, Newborn*
Intestinal Perforation
Magnetic Resonance Imaging
Meconium
Medical Records
Mortality
Prognosis
Retrospective Studies
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