Comparison of Acute Abdominal Surgical Outcomes of Extremely-Low-Birth-Weight Neonates according to Differential Diagnosis
10.3346/jkms.2019.34.e222
- Author:
Jeik BYUN
1
;
Hyun Young KIM
;
Sung Eun JUNG
;
Hee Beom YANG
;
Ee Kyung KIM
;
Seung Han SHIN
;
Han Suk KIM
Author Information
1. Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea. spkhy02@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Extremely Low Birth Weight;
Necrotizing Enterocolitis;
Spontaneous Intestinal Perforation;
Meconium Related Ileus;
Meconium Non-Related Ileus;
Abdominal Surgery
- MeSH:
Abdomen, Acute;
Critical Care;
Diagnosis, Differential;
Enterocolitis, Necrotizing;
Humans;
Ileus;
Infant, Newborn;
Intestinal Perforation;
Magnetic Resonance Imaging;
Meconium;
Medical Records;
Mortality;
Prognosis;
Retrospective Studies
- From:Journal of Korean Medical Science
2019;34(35):e222-
- CountryRepublic of Korea
- Language:English
-
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.
