Exploratory Laparotomy for Necrotizing Enterocolitis

2013 ◽  
Author(s):  
Dugald McAdam
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Necrotizing Enterocolitis ◽  
Very Low Birth Weight ◽  
Survival Rates ◽  
Exploratory Laparotomy ◽  
Extremely Low Birth Weight ◽  
Life Threatening Illness ◽  
Antenatal Steroids ◽  
Neonatal Lung

The survival rates of very-low-birth weight (VLBW; birth weight <1,500 g) and extremely-low-birth weight (ELBW; birth weight <1,000 g) infants have increased with improvements in antenatal and postnatal care. These include the use of antenatal steroids, artificial surfactant, and ventilation strategies that have reduced injury to the neonatal lung. As a result, the pediatric anesthesiologist is now more often faced with the task of safely caring for these infants, often in unfamiliar environments, and sometimes during episodes of life-threatening illness. One example is necrotizing enterocolitis (NEC) requiring surgical management.

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 Routine Administration of a Multispecies Probiotic Containing Bifidobacterium and Lactobacillus to Very Low Birth Weight Infants Had No Significant Impact on the Incidence of Necrotizing Enterocolitis

2021 ◽  
Vol 9 ◽  
Author(s):  
Brian A. Juber ◽  
Timothy J. Boly ◽  
Graeme J. Pitcher ◽  
Steven J. McElroy
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Very Low Birth Weight ◽  
Extremely Low Birth Weight ◽  
Vlbw Infants ◽  
Routine Administration ◽  
Significant Difference ◽  
All Cause Mortality

Background: Necrotizing enterocolitis (NEC) is the leading cause of gastrointestinal morbidity in preterm infants, and prevention and treatment strategies have remained largely unchanged over the past several decades. As understanding of the microbiome has increased, probiotics have been hypothesized as a possible strategy for decreasing rates of NEC, and several studies have noted significant decreases in rates of NEC after initiation of probiotics in preterm infants. However, a recent AAP report cited caution on the use of probiotic use in part because studies of probiotic use in ELBW infants are lacking. As our unit began routine use of probiotics for all infants &lt;33 weeks in 2015 and we are a leading institution for intact survival of ELBW infants, we attempted to answer if probiotic use can impact the rate of NEC in VLBW and ELBW infants.Methods: We conducted a single-center retrospective chart review of infants with modified Bell's stage ≥2a NEC for the 4 years prior to and 5 years after initiation of a protocol involving routine supplementation of a multispecies probiotic to premature infants at the University of Iowa, Stead Family Children's Hospital. The primary outcome measures were rates of modified Bell's stage ≥2a NEC and all-cause pre-discharge mortality at our institution before and after initiation of routine probiotic supplementation in 2015.Results: In our institution, neither the rates of modified Bell's stage ≥2a NEC, nor the rates of all-cause mortality were significantly altered in very low birth weight (VLBW) infants by the initiation of routine probiotic use (NEC rates pre-probiotic 2.1% vs. post-probiotic 1.5%; all-cause mortality rates pre-probiotic 8.4% vs. post-probiotic 7.4%). Characteristics of our two cohorts were overall similar except for a significantly lower 5-minute APGAR score in infants in the post-probiotic epoch (pre-probiotic 8 vs. post-probiotic 6 p = 0.0316), and significantly more infants in the post-probiotic epoch received probiotics (pre-probiotics 0% vs. post-probiotics 65%; p &lt; 0.0001). Similarly, probiotic use had no impact on the incidence of NEC when we restricted our data to only extremely low birth weight (ELBW) infants (pre-probiotics 1.6% vs post-probiotics 4.1%). When we restricted our analysis to only inborn infants, probiotics still had no impact on NEC rates in VLBW infants (1.5% pre- and 1.1% post-probiotic, p = 0.61) or ELBW infants (2% pre- and 2.1% post-probiotic, p = 0.99)Conclusions: Contrary to other studies, we found no significant difference in rates of modified Bell's stage ≥2a NEC or all-cause pre-discharge mortality in VLBW infants following routine administration of a multispecies probiotic supplement.

Probiotics for Preterm Infants: A Premature or Overdue Necrotizing Enterocolitis Prevention Strategy?

2015 ◽  
Vol 34 (2) ◽  
pp. 83-101 ◽  
Author(s):  
Sharon Anderson
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Necrotizing Enterocolitis ◽  
Very Low Birth Weight ◽  
Prevention Strategy ◽  
Extremely Low Birth Weight ◽  
High Risk Population ◽  
Ongoing Research ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

AbstractCommon among preterm, very low birth weight (VLBW) and extremely low birth weight (ELBW) infants, necrotizing enterocolitis (NEC) is a gastrointestinal, infectious disease that remains a leading cause of morbidity and mortality among this high-risk population. To combat this devastating condition, research efforts have been redirected from treatment toward prevention strategies. Although there are several proposed risk-reduction strategies, one intervention gaining support is the administration of prophylactic enteral probiotics. Regardless of growing evidentiary support and a benign safety profile, neonatal providers have yet to embrace this therapy. This article provides an overview of the proposed benefits of probiotics, focusing on their role as a NEC prevention strategy. A review of several sentinel research studies targeting preterm, VLBW, and ELBW infants is provided. Considerations for ongoing research are reviewed. Finally, two evidence-based NEC prevention probiotics protocols are presented.

scholarly journals Necrotizing Enterocolitis with Perforation in an Extreme Preterm, Extremely Low Birth Weight Neonate

2016 ◽  
Vol 36 (2) ◽  
pp. 201-203
Author(s):  
Shridhar Gopalakrishnan ◽  
Shailendra Singh ◽  
Kirandeep Sodhi ◽  
Manu Arora
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Surgical Management ◽  
Necrotizing Enterocolitis ◽  
Very Low Birth Weight ◽  
Extremely Low Birth Weight ◽  
Good Outcome ◽  
Birth Weight Neonate ◽  
Surgical Condition

Necrotizing enterocolitis (NEC) remains the most common and serious surgical condition among preterm, very low birth weight neonates with a mortality of 40% to 50% in those requiring surgery. We report perforation secondary to NEC in an extreme preterm, extremely low birth weight neonate with a good outcome due to aggressive surgical management and intensive care.J Nepal Paediatr Soc 2016;36(2):201-203.

Reduced Formula Intake with Donor Milk (DM) Impacts Necrotizing Enterocolitis (NEC) in Very Low Birth Weight (VLBW) Infants:

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 443A-443A
Author(s):  
Jennifer S. Wicks ◽  
Anita L. Esquerra-Zwiers ◽  
Laura M. Rogers ◽  
Celina M. Scala ◽  
Shirley Chen ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Necrotizing Enterocolitis ◽  
Very Low Birth Weight ◽  
Donor Milk ◽  
Vlbw Infants

scholarly journals Sex-Specific Long-Term Trends in Length of Hospital Stay, Postmenstrual Age at Discharge, and Survival in Very Low Birth Weight Infants

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Matthias Fröhlich ◽  
Tatjana Tissen-Diabaté ◽  
Christoph Bührer ◽  
Stephanie Roll
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Hospital Stay ◽  
Very Low Birth Weight ◽  
Survival Rates ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
Vlbw Infants ◽  
Postmenstrual Age ◽  
Over Time

<b><i>Introduction:</i></b> In very low birth weight (&#x3c;1,500 g, VLBW) infants, morbidity and mortality have decreased substantially during the past decades, and both are known to be lower in girls than in boys. In this study, we assessed sex-specific changes over time in length of hospital stay (LOHS) and postmenstrual age at discharge (PAD), in addition to survival in VLBW infants. <b><i>Methods:</i></b> This is a single-center retrospective cohort analysis based on quality assurance data of VLBW infants born from 1978 to 2018. Estimation of sex-specific LOHS over time was based on infants discharged home from neonatal care or deceased. Estimation of sex-specific PAD over time was based on infants discharged home exclusively. Analysis of in-hospital survival was performed for all VLBW infants. <b><i>Results:</i></b> In 4,336 of 4,499 VLBW infants admitted from 1978 to 2018 with complete data (96.4%), survival rates improved between 1978–1982 and 1993–1997 (70.8 vs. 88.3%; hazard ratio (HR) 0.20, 95% confidence interval 0.14, 0.30) and remained stable thereafter. Boys had consistently higher mortality rates than girls (15 vs. 12%, HR 1.23 [1.05, 1.45]). Nonsurviving boys died later compared to nonsurviving girls (adjusted mean survival time 23.0 [18.0, 27.9] vs. 20.7 [15.0, 26.3] days). LOHS and PAD assessed in 3,166 survivors displayed a continuous decrease over time (1978–1982 vs. 2013–2018: LOHS days 82.9 [79.3, 86.5] vs. 60.3 [58.4, 62.1] days); PAD 40.4 (39.9, 40.9) vs. 37.4 [37.1, 37.6] weeks). Girls had shorter LOHS than boys (69.4 [68.0, 70.8] vs. 73.0 [71.6, 74.4] days) and were discharged with lower PAD (38.6 [38.4, 38.8] vs. 39.2 [39.0, 39.4] weeks). <b><i>Discussion/Conclusions:</i></b> LOHS and PAD decreased over the last 40 years, while survival rates improved. Male sex was associated with longer LOHS, higher PAD, and higher mortality rates.

scholarly journals Pregnancy Outcome during the First COVID 19 Lockdown in Vienna, Austria

2021 ◽  
Vol 18 (7) ◽  
pp. 3782
Author(s):  
Sylvia Kirchengast ◽  
Beda Hartmann
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Pregnancy Outcome ◽  
Gestational Age ◽  
Very Low Birth Weight ◽  
Extremely Low Birth Weight ◽  
Negative Effects ◽  
Gestational Length ◽  
Live Births

The COVID 19 pandemic represents a major stress factor for non-infected pregnant women. Although maternal stress during pregnancy increases the risk of preterm birth and intrauterine growth restriction, an increasing number of studies yielded no negative effects of COVID 19 lockdowns on pregnancy outcome. The present study focused on pregnancy outcome during the first COVID 19 lockdown phase in Austria. In particular, it was hypothesized that the national lockdown had no negative effects on birth weight, low birth weight rate and preterm birth rate. In a retrospective medical record-based single center study, the outcome of 669 singleton live births in Vienna Austria during the lockdown phase between March and July 2020 was compared with the pregnancy outcome of 277 live births at the same hospital during the pre-lockdown months of January and February 2020 and, in addition, with the outcome of 28,807 live births between 2005 and 2019. The rate of very low gestational age was significantly lower during the lockdown phase than during the pre-lockdown phase. The rate of low gestational age, however, was slightly higher during the lockdown phase. Mean birth weight was significantly higher during the lockdown phase; the rates of low birth weight, very low birth weight and extremely low birth weight were significantly lower during the lockdown phase. In contrast, maternal gestational weight gain was significantly higher during the lockdown phase. The stressful lockdown phase in Austria seems to have no negative affect on gestational length and newborn weight among non-infected mothers.

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