Publication:


abstract

Background: Necrotizing enterocolitis (NEC) and focal intestinal Perforation (FIP) are major causes of morbidity in Infants with Extremely Low Birth Weight (ELBW). Objective: To evaluate the Surgical procedures applied, and the survival and long-term outcome of ELBW infants with NEC and FIP in a Single-Center study. Methods: Inborn and outborn ELBW infants (<1000 g) with NEC and FIP were analyzed retrospectively from 2002 to 2007. Data collected include surgical procedures, survival as well as complications, length of partial parenteral nutrition and hospital stay. The short-term and long-term outcomes after 2-7 years were assessed and compared with a matched control group. Results: Out of 280 ELBW infants, 28 underwent surgery, 19 because of FIP and 9 for NEC. Fourteen infants in the FIP group were treated with primary laparotomy and 5 with peritoneal drainage (PD). In the NEC group, only 1 infant was treated with PD. PD was used for unstable patients and was always followed by secondary laparotomy after stabilization. Five of 28 (18%) surgically treated ELBW infants and 4 (14%) matched controls died. The following complications occurred in the surgical group: complete (n = 1) or minor wound dehiscence (n = 4), stoma prolapse (n = 5), parastomal hernia (n = 2), stoma fistula (n = 1), and wound infection (n = 2). Dependency on parenteral nutrition was significantly shorter in infants with FIP, while there were no differences in time to stoma closure and length of hospital stay between those with FIP and those with NEC. Eleven of 23 (47.8%) surviving patients with FIP or NEC showed developmental delay, compared with 9 of 24 (37.5%) in the controls. Conclusions: The Management of EBLW infants with NEC and FIP remains challenging. Our treatment approach was associated with low mortality. Developmental delay seems to be caused by extreme prematurity rather than NEC- or FIP-related Bowel perforation.

Copyright © 2012 S. Karger AG, Basel.

Related Articles
Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation: a prospective cohort study by the NICHD Neonatal Research Network.
Ann Surg. 2005
Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation: a prospective cohort study by the NICHD Neonatal Research Network.
Blakely ML, Lally KP, McDonald S, Brown RL, Barnhart DC, Ricketts RR, Thompson WR, Scherer LR, Klein MD, Letton RW, et al. Ann Surg. 2005 Jun; 241(6):984-9; discussion 989-94.
A national short-term follow-Up study of extremely low birth weight infants born in Finland in 1996-1997.
Pediatrics. 2001
A national short-term follow-Up study of extremely low birth weight infants born in Finland in 1996-1997.
Tommiska V, Heinonen K, Ikonen S, Kero P, Pokela ML, Renlund M, Virtanen M, Fellman V. Pediatrics. 2001 Jan; 107(1):E2.
Necrotizing enterocolitis complicated with perforation in extremely low birth-weight premature infants.
Acta Paediatr Taiwan. 2002
Necrotizing enterocolitis complicated with perforation in extremely low birth-weight premature infants.
Wu CH, Tsao PN, Chou HC, Tang JR, Chan WK, Tsou KI. Acta Paediatr Taiwan. 2002 May-Jun; 43(3):127-32.
Review Evidence vs experience in the surgical management of necrotizing enterocolitis and focal intestinal perforation.
J Perinatol. 2008
Review Evidence vs experience in the surgical management of necrotizing enterocolitis and focal intestinal perforation.
Hunter CJ, Chokshi N, Ford HR. J Perinatol. 2008 May; 28 Suppl 1:S14-7.
Review Prophylactic surgical ligation of patent ductus arteriosus for prevention of mortality and morbidity in extremely low birth weight infants.
Cochrane Database Syst Rev. 2008
Review Prophylactic surgical ligation of patent ductus arteriosus for prevention of mortality and morbidity in extremely low birth weight infants.
Mosalli R, Alfaleh K. Cochrane Database Syst Rev. 2008 Jan 23; (1):CD006181. Epub 2008 Jan 23.