-
Archives of Surgery (Chicago, Ill. :... Aug 1998To review the morbidity and mortality among 68 premature infants treated with enterostomy for necrotizing enterocolitis.
OBJECTIVE
To review the morbidity and mortality among 68 premature infants treated with enterostomy for necrotizing enterocolitis.
DESIGN
Data were collected retrospectively from hospital medical records to include the period between January 1, 1987, and September 30, 1997.
SETTING
Tertiary care children's hospital.
PATIENTS
A group of 68 infants aged 2 to 35 days (mean age, 12.5 days), weighing 1500 g or less, with necrotizing enterocolitis necessitating surgical enterostomy for treatment.
INTERVENTIONS
Creation of any enterostomy during exploratory laparotomy for necrotizing enterocolitis and subsequent closure.
MAIN OUTCOME MEASURES
Morbidity and mortality associated with infant enterostomy and its closure.
RESULTS
Thirty-nine infants underwent ileostomy with mucous fistula, 16 underwent ileostomy with a Hartmann pouch, 7 had jejunostomy with mucous fistula, 2 had colostomy with mucous fistula, and 4 had colostomy with a Hartmann pouch. Eighteen (26%) of the 68 infants died in the postoperative period of sepsis (n = 10), continuing necrotizing enterocolitis (n = 5), or respiratory distress (n = 3). Of the remaining 50 infants, complications developed in 34 (68%). These complications included strictures requiring further resection at the time of enterostomy closure in 20 infants; stricture of the enterostomy requiring surgical revision in 6; incisional hernia in 3; parastomal hernia in 4; enterostomal prolapse or intussusception in 6 and 1, respectively; wound dehiscence in 4; wound infection in 8; small-bowel obstruction requiring laparotomy in 2; and anastomotic complications in 2. Only 16 enterostomies were closed uneventfully, with 3 of these infants subsequently dying of sudden infant death syndrome between 6 and 8 months after the operation. Of the surviving infants, 3 (6%) continue to require home hyperalimentation.
CONCLUSIONS
Although enterostomy in infants with low birth weight with necrotizing enterocolitis may be lifesaving, it is also a major cause of morbidity. These data suggest the feasibility of a prospective study comparing resection and primary anastomosis with resection and enterostomy.
Topics: Enterocolitis, Pseudomembranous; Enterostomy; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Intestinal Perforation; Retrospective Studies; Treatment Outcome
PubMed: 9711962
DOI: 10.1001/archsurg.133.8.875 -
Journal of Perinatology : Official... May 2022To identify risk factors associated with high-frequency ventilation (HFV) following definitive closure of the patent ductus arteriosus (PDA).
OBJECTIVE
To identify risk factors associated with high-frequency ventilation (HFV) following definitive closure of the patent ductus arteriosus (PDA).
METHODS
We performed a retrospective study of premature infants (<37 weeks) who were mechanically ventilated before and after surgical or transcatheter PDA closure. Primary outcome was HFV requirement within 24 h of procedure. Logistic regression was used to estimate clinical associations with post procedure HFV requirement.
RESULTS
We identified 110 infants who were mechanically ventilated before PDA closure, of which 48 (44%) escalated to HFV within 24 h after closure. In the multivariable model, surgical ligation (OR 21.5, 95% CI 1.6-284), elevated Respiratory Severity Score (RSS) 1 h post-procedure (OR 1.78, 95% CI 1.07-2.99) and 12 h post-procedure (OR 2.12, 95% CI 1.37-3.26) were independent predictors of HFV.
CONCLUSION
Surgical ligation and elevated RSS values over the first 12 h after PDA closure are risk factors for HFV.
Topics: Ductus Arteriosus, Patent; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Ligation; Retrospective Studies
PubMed: 34650199
DOI: 10.1038/s41372-021-01226-z -
Hernia : the Journal of Hernias and... Jun 2014Premature infants treated with laparostomy in the first days of their life represent a group of complex patients with high morbidity and mortality rates. Laparostomy is...
BACKGROUND
Premature infants treated with laparostomy in the first days of their life represent a group of complex patients with high morbidity and mortality rates. Laparostomy is a surgical treatment method in which the peritoneal cavity is opened anteriorly and deliberately left open, hence often called "open abdomen". The aim of this study was to analyze crucial factors influencing the postoperative outcome of premature infants treated this way.
METHODS
Between March 2002 and August 2012, we treated 40 premature infants with a median gestational age of 29 weeks (range from 24 to 34 weeks) with open abdomen in our institution. Their data were analyzed retrospectively. They were divided into two groups depending on in-hospital survival.
RESULTS
Indications for surgery were ileus (n = 16), spontaneous intestinal perforation (n = 11), gastroschisis (n = 8) and necrotizing enterocolitis (NEC, n = 5). The overall in-hospital mortality was 43 % (17 of 40 patients). Postoperative anemia was the only significant factor influencing mortality rates in our patients (10 vs. 14 patients; p = 0.028). Neither the indication of surgery, nor week of gestation, nor birth weight had any significant influence on postoperative survival. Twenty-one of the 23 surviving patients reached fascia closure.
CONCLUSIONS
In our study, outcome of premature infants with open abdomen in the first days of their life seems to depend more on an operation and a postoperative course without complications than on the preoperative conditions of the children. Postoperative anemia seems to be a significant negative prognostic marker. Patients reaching fascia closure mainly survive.
Topics: Abdominal Wall; Anemia; Female; Gastroschisis; Hospital Mortality; Humans; Infant, Newborn; Infant, Premature; Intestinal Diseases; Laparotomy; Male; Prognosis; Retrospective Studies
PubMed: 24509864
DOI: 10.1007/s10029-014-1226-8 -
Cardiovascular Journal of South Africa... 2001The incidence of persistent patency of the ductus arteriosus (PDA) is inversely related to birth weight. A PDA contributes to pathological conditions in the neonate and... (Comparative Study)
Comparative Study
The incidence of persistent patency of the ductus arteriosus (PDA) is inversely related to birth weight. A PDA contributes to pathological conditions in the neonate and timely closure in these low-L birth-L weight infants could potentially prevent these complications. Prostaglandin inhibition with indomethacin is one treatment strategy currently available. This retrospective descriptive study evaluated the parameters that influenced the effectiveness of indomethacin in closure of the PDA in 101 consecutive premature infants and the adverse effects of indomethacin in these infants. Independent variables found to increase the risk of unsuccessful closure with indomethacin significantly were caesarean section, lower haematocrit at delivery and severity of hyaline membrane disease. Non-L closure also resulted in prolonged ventilation. No significant adverse effects were recorded in the infants who received indomethacin but neonatal jaundice was more common in those infants who responded to indomethacin.
Topics: Birth Weight; Cardiovascular Agents; Cardiovascular Surgical Procedures; Combined Modality Therapy; Ductus Arteriosus, Patent; Female; Follow-Up Studies; Humans; Indomethacin; Infant Welfare; Infant, Newborn; Infant, Premature; Length of Stay; Male; Maternal Age; Retrospective Studies; Risk Factors; Sex Factors
PubMed: 11753466
DOI: No ID Found -
Research Square Apr 2024Myelomeningocele (MMC) is the most common neural tube defect, but rarely seen in premature infants. Most centers advocate for closure of MMC within 24 hours of birth....
INTRODUCTION
Myelomeningocele (MMC) is the most common neural tube defect, but rarely seen in premature infants. Most centers advocate for closure of MMC within 24 hours of birth. However, this is not always possible in severely premature infants. Given the rarity of this patient population, we aimed to share our institutional experience and outcomes of severely premature infants with MMC.
METHODS
We performed a retrospective, observational review of premature infants (≤ 32 weeks gestational age) identified through our multidisciplinary spina bifida clinic (1995-2021) and surgical logs. Descriptive statistics were compiled about this sample including timing of MMC closure and incidence of adverse events such as sepsis, CSF diversion, meningitis, and death.
RESULTS
Eight patients were identified (50% male) with MMC who were born ≤ 32 weeks gestational age. Mean gestational age of the population was 27.3 weeks (SD 3.5). Median time to MMC closure was 1.5 days (IQR = 1 -80.8). Five patients were taken for surgery within the recommended 48 hours of birth; 2 patients underwent significantly delayed closure (107 and 139 days); and one patient's defect epithelized without surgical intervention. Six of eight patients required permanent cerebrospinal fluid (CSF) diversion (2 patients were treated with ventriculoperitoneal shunting (VPS), three were treated with endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) and 1 patient treated with ETV; mean of 3 years after birth, ranging from 1 day to 16 years). Two patients required more than one permanent CSF diversion procedure. Two patients developed sepsis (defined as meeting at least 2/4 SIRS criteria), and 2 patients had intraventricular hemorrhage (both grade III). No patients developed meningitis (defined as positive CSF cultures) prior to MMC closure. Median follow up duration was 9.7 years. During this time epoch, 3 patients died: Two before 2 years of age of causes unrelated to surgical intervention. One of the two patients with grade III IVH died within 24 hours of MMC closure.
CONCLUSIONS
In our institutional experience with premature infants with MMC, some patients underwent delayed MMC closure. The overall rate of meningitis, sepsis, and mortality for preterm children with MMC was similar to MMC patients born at term.
PubMed: 38645257
DOI: 10.21203/rs.3.rs-4158288/v1 -
The Annals of Thoracic Surgery Jan 2006Surgical closure of ductus arteriosus is commonly indicated in premature newborns. The aim of this study was to assess short-term and mid-term effects of delayed... (Comparative Study)
Comparative Study
BACKGROUND
Surgical closure of ductus arteriosus is commonly indicated in premature newborns. The aim of this study was to assess short-term and mid-term effects of delayed surgical closure of the ductus arteriosus on respiratory and digestive outcome in extremely preterm infants.
METHODS
We retrospectively studied 58 infants less than 28 weeks gestational age who underwent surgical closure of ductus arteriosus between January 1997 and December 2002. Nine infants with intrauterine growth restriction and major congenital malformation were excluded from the study. Criteria for surgical closure of ductus arteriosus were: (1) medical treatment failure (ie, indomethacin or ibuprofen) and (2) hemodynamically patent ductus arteriosus: systemic arterial pressure less than gestational age in mm Hg, heart failure, left atrial-aortic root ratio greater than 1.6, mean velocity in the left pulmonary artery greater than 0.6 m/s, and ductus arteriosus diameter greater than 3 mm. Infants were divided into two groups: (1) the early group who had surgery before 21 days of life (n = 31), and (2) the late group who had surgery after 21 days of life (n = 27). Preoperative and postoperative criteria were compared between the two groups (ie, gestational age, birth weight, hemodynamic, ventilatory, and echographic [left atrial-aortic root ratio, mean velocity in the left pulmonary artery] parameters).
RESULTS
Preoperative gestational age and birth weight did not differ between the two groups. In the early group, gestational age was 26 weeks (range, 23 to 28 weeks and birth weight was 800 g (range, 630 to 1,240 g). In the late group, gestational age was 26 weeks (range, 24 to 28 weeks) and birth weight was 840 g (530 to 1,130 g). Hemodynamic, ventilatory, and echographic parameters were similar in both groups. Rate of bronchopulmonary dysplasia was similar in both groups. However, at 24 hours post surgery, median FiO2 was higher in the late group (28% [range, 21% to 65%]) than in early group (21% [range, 21% to 60%]) (p < 0.05). Furthermore, full oral feeding was acquired later in the late group (57 days of life [range, 30 to 136 days]) than in the early group (37 days of life [range, 27 to 84 days]) (p < 0.01), and body weight at 36 weeks of post-conceptional age was higher in the early group at 1,800 g (range, 1,250 to 2,750 g) than in the late group at 1,607 g (1,274 to 2,200 g) (p < 0.05).
CONCLUSIONS
Our findings show that early surgical closure of the ductus arteriosus (< 3 weeks of life) is associated with shortened delay for full oral feeding and improved body growth when compared with late surgical closure (> 3 weeks of life).
Topics: Combined Modality Therapy; Ductus Arteriosus, Patent; Enteral Nutrition; Female; Gestational Age; Humans; Ibuprofen; Indomethacin; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Male; Postoperative Complications; Retrospective Studies; Time Factors; Treatment Outcome; Weight Gain
PubMed: 16368371
DOI: 10.1016/j.athoracsur.2005.03.141 -
American Journal of Perinatology 1998Aortopulmonary collaterals occur in a variety of congenital heart diseases, in chronic pulmonary infection and abscesses, in association with lung tumors, and after...
Aortopulmonary collaterals occur in a variety of congenital heart diseases, in chronic pulmonary infection and abscesses, in association with lung tumors, and after multiple pulmonary emboli. In patients with congenital cyanotic heart disease aortopulmonary collaterals mainly occur in conditions with reduced pulmonary blood flow. We investigated 12 preterm low-birth-weight infants, gestational age 29.3+/-3.3 weeks, with respiratory failure who suffered from moderate to severe chronic lung disease after a period of mechanical ventilation. All patients developed aortopulmonary collaterals after closure of a patent ductus arteriosus. Aortopulmonary collaterals could be displayed clearly by color Doppler echocardiography and originated mainly from the descending aorta or the aortic arch. Hypoxic and hypercapnic episodes favored the development of aortopulmonary collaterals, which disappeared after pulmonary hemodynamics and respiratory function had improved. In only one patient coiling of a large col lateral vessel had to be performed. Systemic-to-pulmonary collateral vessels potentially aggravate chronic lung disease by increasing collateral pulmonary blood flow and reducing lung compliance. We conclude that aortopulmonary collaterals occur in bronchopulmonary dysplasia and can cause major problems in ventilated premature infants. Echocardiographic evaluation is important to prevent aggravation of chronic lung disease of infants at risk.
Topics: Aorta, Thoracic; Bronchopulmonary Dysplasia; Collateral Circulation; Ductus Arteriosus; Echocardiography, Doppler, Color; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Male; Pulmonary Circulation; Respiration, Artificial; Respiratory Insufficiency; Retrospective Studies
PubMed: 9926877
DOI: 10.1055/s-2007-994061 -
Journal of Pediatric Surgery Jun 1975During the period from February, 1971 to February, 1973, 30 premature infants underwent surgical ligation of patent ductus arteriosus. The gestational ages ranged from...
During the period from February, 1971 to February, 1973, 30 premature infants underwent surgical ligation of patent ductus arteriosus. The gestational ages ranged from 25 to 36 wk (mean 30), and the birth weights ranged from 760 to 2010 g (mean 1274). The patients were divided into two groups on the basis of the indications for assisted ventilation. Group I consisted of 21 patients with severe hylanine membrane disease who required assisted ventilation during the first 2 days of life and could not be weaned off the respiratory by 10 days of age. Group II was composed of nine infants who required intermittent positive-pressure breathing after a mean age of 8 days because of repeated apneic spells secondary to uncontrollable heart failure. All infants in Group II survived the operation and left the hospital well. Fourteen of the 21 patients in Group I survived; the seven deaths were all due to underlying severe pulmonary disease (bronchopulmonary dysplasia). The value of PDA ligation in premature infants with uncontrollable heart failure is demonstrated in this study; this procedure also appears to be beneficial in neonates with severe respiratory distress syndrome.
Topics: Aortography; Apnea; Birth Weight; Blood Pressure; Ductus Arteriosus, Patent; Electrocardiography; Female; Gestational Age; Heart Diseases; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Premature; Male; Oximetry; Positive-Pressure Respiration; Respiration, Artificial
PubMed: 1095712
DOI: 10.1016/0022-3468(75)90103-7 -
The Journal of Pediatrics Dec 1991
Topics: Ductus Arteriosus; Echocardiography; Echocardiography, Doppler; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Prospective Studies
PubMed: 1960622
DOI: 10.1016/s0022-3476(05)83060-4 -
Frontiers in Cardiovascular Medicine 2019An asymptomatic Atrial Septal Defect (ASD) is often closed at the age of 3-5 years using a transcatheter or surgical technique. Symptomatic ASD or ASD associated with...
An asymptomatic Atrial Septal Defect (ASD) is often closed at the age of 3-5 years using a transcatheter or surgical technique. Symptomatic ASD or ASD associated with pulmonary hypertension (PHT) may require earlier closure, particularly in combination with other non-cardiac risk factors for PHT, but the indications for early closure and the potential risk for complications are largely unknown. The aim of this study was to assess risk factors for needing ASD closure during the first and second years of life. This case-control study included all children treated with surgical or percutaneous ASD closure between 2000 and 2014 at two out of three pediatric heart centers in Sweden. "Cases" were children with ASD closure at ≤1 or ≤2 years of age. Clinical data were retrieved from medical journals and national registries. Overall, 413 children were included. Of these, 131 (32%) were ≤2 years, and 50 (12%) were ≤1 year. Risk factors associated with a ≤2 years ASD closure were preterm birth, OR = 2.4 (95% CI: 1.5-3.9); additional chromosomal abnormalities, OR = 3.4 (95% CI: 1.8-6.5); pulmonary hypertension, OR = 5.8 (95% CI: 2.6-12.6); and additional congenital heart defects, OR = 2.6 (95% CI: 1.7-4.1). These risk associations remained after adjustments for confounding factors, such as need for neonatal respiratory support, neonatal pulmonary diseases, neonatal sepsis, additional congenital heart defects (CHD) and chromosomal abnormalities. ASD size:body weight ratio of 2.0, as well as a ratio of 0.8 (upper and lower limit of the ASD size:body weight ratios), was associated with increased risk of an early ASD closure. Risk factors such as very premature birth, very low birth weight, congenital, and chromosomal abnormalities, neonatal pulmonary disease and need for ventilation support, as well as pulmonary hypertension, were associated with very early (<1 year of age) ASD closure. Several independent neonatal risk factors were associated with an increased risk of early ASD closure at 2 and at 1 year of age. An ASD size:body weight ratio is a poor predictor for indications for ASD closure.
PubMed: 31998753
DOI: 10.3389/fcvm.2019.00185