Exploratory Laparotomy for Necrotizing Enterocolitis

2018 ◽  
Author(s):  
Karla E. K. Wyatt ◽  
Olutoyin A. Olutoye
Keyword(s):  
Risk Factors ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Exploratory Laparotomy ◽  
Anesthesia Care ◽  
Comorbid Conditions ◽  
Surgical Interventions ◽  
Pediatric Anesthesiologist ◽  
Inflammatory Bowel

Necrotizing enterocolitis (NEC) is a severe inflammatory bowel disease that commonly affects premature infants. The pathogenesis is multifactorial and poorly understood, although certain risk factors have been identified. This disease, more commonly detected in premature infants with accompanying cardiac and pulmonary comorbid conditions, is associated with increased morbidity and mortality. Multiorgan system homeostasis becomes critical for the pediatric anesthesiologist when approaching medical and surgical interventions for affected patients. This chapter focuses on the population at risk for developing necrotizing enterocolitis, medical and surgical management, providing anesthesia care in the neonatal intensive care unit, as well as perioperative considerations and complications.

scholarly journals Outcome of primary peritoneal drainage in perforated necrotizing enterocolitis: an experience with 96 infants

2021 ◽  
Author(s):  
Kumar Abdul Rashid ◽  
Reyaz Ahmad Wani ◽  
Shafat Ahmad Tak ◽  
Omar Masood ◽  
Amat U. Samie ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Exploratory Laparotomy ◽  
Extremely Low Birth Weight ◽  
Major Surgery ◽  
Low Birth Weight Infants ◽  
Peritoneal Drainage

Background: Necrotizing enterocolitis is a life-threatening inflammation of neonatal intestine of multifactorial etiology. In early stages, medical management is considered; while as a transmural disease with pneumatosis or perforation needs surgical attention. Primary peritoneal drainage has evolved as an alternative to classic exploratory laparotomy especially in sick preterm and very low birth weight infants.Methods: In our study, we tried to employ primary peritoneal drainage as an initial intervention in all surgical necrotizing enterocolitis patients and analyzed the results and final outcome in terms of total days in neonatal intensive care unit, total parenteral nutrition days, days to start oral feeds, need for laparotomy, mortality and other complications.Results: Around one-third patients were either very low or extremely low birth weight and 80% patients were preterm. Primary peritoneal drainage was successful without need for laparotomy in around 65% of patients. In the rest 34 patients, 24 were subjected to rescue laparotomy, while 10 could not be stabilized for major surgery. Overall mortality was 29.16%.Conclusions: Early bedside primary peritoneal drainage can be employed in all cases of NEC with perforation with rescue laparotomy to be determined by subsequent monitoring. This strategy seems to be safe and cost-effective in a resource challenged set up and lifesaving in sick and extremely low birth weight infants.

scholarly journals Risk factors for necrotizing enterocolitis in neonates:a prospective study

2019 ◽  
Vol 6 (4) ◽  
pp. 1598
Author(s):  
Manas Ranjan Sahoo ◽  
Pydi Nagasree ◽  
Lanka Swetha ◽  
Arigela Vasundhara
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Prospective Study ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Pregnancy Induced Hypertension ◽  
Mortality And Morbidity ◽  
Maternal Risk ◽  
Induced Hypertension

Background: Necrotizing enterocolitis (NEC) is mostly limited to preterm babies due to immaturity of gut. NEC is one of important cause of neonatal mortality and morbidity in the neonatal intensive care units all over the world.Aim of study is to find the antenatal and post-natal risk factors associated with necrotizing enterocolitis in neonates admitted to NICU.Methods: A prospective study was conducted on 45 neonates with necrotizing enterocolitis fulfilling the predetermined inclusion criteria. A detailed antenatal history including all maternal risk factors, birth history including the need for resuscitation and type of resuscitation was recorded. The gestational assessment was done by the New Ballard Score.Results: Pregnancy induced hypertension accounts as a risk factor to most of the cases of NEC 18 (40%), followed by setting for sepsis 12 (26.6%), least being gestational diabetes mellitus 1 (2.2%).Conclusions: Prematurity is found to be the most common risk factor followed by patent ductus arteriosus and sepsis. Most common antenatal risk factor was PIH (Pregnancy induced hypertension).

scholarly journals IL-17-related signature genes linked to human necrotizing enterocolitis

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Éric Tremblay ◽  
Emanuela Ferretti ◽  
Corentin Babakissa ◽  
Karolina Maria Burghardt ◽  
Emile Levy ◽  
...  
Keyword(s):  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Gastrointestinal Disease ◽  
Enrichment Analysis ◽  
Gene Set Enrichment Analysis ◽  
Neonatal Intensive Care Units ◽  
Immune Functions ◽  
Signature Genes ◽  
Life Threatening ◽  
Inflammatory Bowel

Abstract Objective Necrotizing enterocolitis (NEC) is the most frequent life-threatening gastrointestinal disease experienced by premature infants in neonatal intensive care units all over the world. The objective of the present study was to take advantage of RNA-Seq data from the analysis of intestinal specimens of preterm infants diagnosed with NEC. Function enrichments with Gene Ontology and the Kyoto Encyclopedia of Genes and Genomes were used to analyse previous data in order to identify biological and functional processes, which could provide more insight into the pathogenesis of NEC in infants. Results Gene set enrichment analysis indicated that the most significant biological pathways over-represented in NEC neonates were closely associated with innate immune functions. One of the striking observations was the highly modulated expression of inflammatory genes related to the IL-17 pathway including such as pro-inflammatory cytokines (CXCL8), chemokines (CXCL5 and CXCL10) and antimicrobials (DEF5A, DEF6A, LCN2, NOS2) in the intestine of neonates diagnosed with NEC. Interestingly, the increase in IL-17 expression appeared to be under the IL-17F form, as reported in Crohn's disease, another inflammatory bowel disease. Further investigation is thus still needed to determine the precise role of IL-17F and its downstream targets in NEC.

PREDICTION MODEL OF PROBABILITY ESTIMATE OF FATAL CASES IN INFANTS WITH CONGENITAL MALFORMATIONS IN SURGICAL INTERVENTIONS

2021 ◽  
Vol 8 (2) ◽  
pp. 57-61
Author(s):  
Alexey O. Vlasov ◽  
Iryna A. Holovanova
Keyword(s):  
Risk Factors ◽  
Prediction Model ◽  
Congenital Malformations ◽  
Surgical Correction ◽  
Anesthesia Care ◽  
Surgical Interventions ◽  
Different Types ◽  
Combined Anesthesia ◽  
Simple Logistic

Aim: To evaluate different types of combined anesthesia in surgical correction of congenital malformations in infants and to develop a prediction model of the association of risk factors and fatal cases in chosen methods of anesthesia care. Material and methods: The retrospective study included newborns and infants with congenital malformations, who received and continued phased surgical treatment. Determination of risk factors was performed by the method of simple logistic regression with the calculation of the odds ratio (OR), 95% confidence interval (95% CI). Results: A total of 150 children were included in the study. The risk factors for deaths in the surgical correction of congenital malformations in children have been established, a prognostic model has been created. Conclusions: To prevent fatal cases in various types of surgery and options for anesthesia care of newborns and infants with CM, it is advisable to more closely monitor the cerebral, peripheral oximetry at all stages of treatment and timely correct the impaired condition of the child.

scholarly journals Extremely Premature Infants

2018 ◽  
pp. 59-62
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Birth Weight ◽  
Survival Rate ◽  
Preterm Infants ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Treatment Approach ◽  
Extreme Prematurity ◽  
Care Services

Extreme prematurity describes infants born under 28 weeks. In recent years, there has been an increase in the survival rate of extremely premature infants with extremely low birth week and birth weight due to improvements in neonatal intensive care services. As a result, an increase in the number of cases with retinopathy of prematurity (ROP) is observed. Moreover, the frequency of the ROP treatment was extremely high in preterm infants with a gestational age of fewer than 28 weeks. In this article, the incidence of ROP, risk factors, clinical features, and treatment approach were reviewed in extremely premature infants.

scholarly journals New modified version of the Risk Adjustment for Congenital Heart Surgery category and mortality in premature infants with critical congenital heart disease

2020 ◽  
Vol 63 (10) ◽  
pp. 395-401 ◽  
Author(s):  
Young Mi Yoon ◽  
Seong Phil Bae ◽  
Yoon-Joo Kim ◽  
Jae Gun Kwak ◽  
Woong-Han Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Birth Weight ◽  
Premature Infants ◽  
Risk Adjustment ◽  
Neonatal Intensive Care ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Median Birth Weight

Background: Despite advances in neonatal intensive care and surgical procedures, perinatal mortality rates for premature infants with congenital heart disease (CHD) remain relatively high.Purpose: We aimed to describe the outcomes of premature infants with critical CHD and identify the risk factors including the new modified version of the Risk Adjustment for Congenital Heart Surgery (M-RACHS) category associated with in-hospital mortality in a Korean tertiary center.Methods: This was a retrospective cohort study of premature infants with critical CHD admitted to the neonatal intensive care unit from January 2005 to December 2016.Results: A total of 78 premature infants were enrolled. The median gestational age (GA) at birth was 34.9 weeks (range, 26.7–36.9 weeks), and the median birth weight was 1.91 kg (range, 0.53–4.38 kg). Surgical or percutaneous intervention was performed in 68 patients with a median GA at birth of 34.7 weeks (range, 26.7–36.8 weeks) and a median birth weight of 1.92 kg (range, 0.53–4.38 kg). The in-hospital survival rate was 76.9% among all enrolled preterm infants and 86.8% among patients who received an intervention. Very low birth weight (VLBW), persistent pulmonary hypertension of the newborn (PPHN), bronchopulmonary dysplasia (BPD), and M-RACHS category 5 or higher (more complex CHD) were independently associated with in-hospital mortality. For the 68 premature infants undergoing cardiac interventions, independent risk factors for mortality were VLBW, BPD, and CHD complexity. Late preterm infant and age at intervention were not associated with patient survival.Conclusion: For premature infants with critical CHD, VLBW, PPHN, BPD, and M-RACHS category ≥5 were risk factors for mortality. A careful approach to surgical intervention and prenatal care should be taken according to CHD type and neonatal condition.

scholarly journals Low plasma concentrations of arginine and asymmetric dimethylarginine in premature infants with necrotizing enterocolitis

2007 ◽  
Vol 97 (5) ◽  
pp. 906-911 ◽  
Author(s):  
Milan C. Richir ◽  
Michiel P. C. Siroen ◽  
Ruurd M. van Elburg ◽  
Willem P. F. Fetter ◽  
Freeke Quik ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Birth Weight ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Asymmetric Dimethylarginine ◽  
Plasma Concentrations ◽  
Nos Inhibitor ◽  
Oxide Synthase

Several studies have described reduced plasma concentrations of arginine, the substrate for nitric oxide synthase (NOS) in infants with necrotizing enterocolitis (NEC). No information on the plasma concentrations of the endogenous NOS inhibitor asymmetric dimethylarginine (ADMA) in patients with NEC is currently available. We investigated whether plasma concentrations of arginine, ADMA, and their ratio differ between premature infants with and without NEC, and between survivors and non-survivors within the NEC group. In a prospective case–control study, arginine and ADMA concentrations were measured in ten premature infants with NEC (median gestational age 193 d, birth weight 968 g), and ten matched control infants (median gestational age 201 d, birth weight 1102 g), who were admitted to the Neonatal Intensive Care Unit. In the premature infants with NEC, median arginine and ADMA concentrations (μmol/l), and the arginine:ADMA ratio were lower compared to the infants without NEC: 21·4 v. 55·9, P = 0·001; 0·59 v. 0·85, P = 0·009 and 36·6 v. 72·3, P = 0·023 respectively. In the NEC group, median arginine (μmol/l) and the arginine:ADMA ratio were lower in non-surviving infants than in surviving infants: 14·7 v. 33·8, P = 0·01 and 32·0 v. 47·5, P = 0·038 respectively. In premature infants with NEC not only the NOS substrate arginine, but also the endogenous NOS inhibitor ADMA and the arginine:ADMA ratio were lower than in infants without NEC. In addition, low arginine and arginine:ADMA were associated with mortality in infants with NEC. Overall, these data suggest that a diminished nitric oxide production may be involved in the pathophysiology of NEC, but this needs further investigation.

scholarly journals Neonatal Necrotizing Enterocolitis

2011 ◽  
Vol 11 ◽  
pp. 655-656
Author(s):  
Saad Lahmiti ◽  
Abdelmounaim Aboussad
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Gastrointestinal Disease ◽  
Gastrointestinal Disorder ◽  
X Ray ◽  
Infection And Inflammation ◽  
Neonatal Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is a gastrointestinal disease that mostly affects premature infants. It involves infection and inflammation that causes destruction of the bowel. Although it affects only 1 in 2,000 to 4,000 births, or between 1 and 5% of neonatal intensive care unit admissions, NEC is the most common and serious gastrointestinal disorder among hospitalized preterm infants. We present a very representative abdominal X-ray of this disease.

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