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Comparison of Acute Abdominal Surgical Outcomes of Extremely-Low-Birth-Weight Neonates according to Differential Diagnosis

Journal of Korean Medical Science 2019년 34권 35호 p.222 ~ 222
 ( Byun Je-ik ) - Seoul National University College of Medicine Seoul National University Children’s Hospital Department of Surgery

 ( Kim Hyun-Young ) - Seoul National University College of Medicine Seoul National University Children’s Hospital Department of Surgery
 ( Jung Sung-Eun ) - Seoul National University College of Medicine Seoul National University Children’s Hospital Department of Surgery
 ( Yang Hee-Beom ) - Seoul National University College of Medicine Seoul National University Children’s Hospital Department of Surgery
 ( Kim Ee-Kyung ) - Seoul National University College of Medicine Seoul National University Children’s Hospital Department of Pediatrics
 ( Shin Seung-Han ) - Seoul National University College of Medicine Seoul National University Children’s Hospital Department of Pediatrics
 ( Kim Han-Suk ) - Seoul National University College of Medicine Seoul National University Children’s Hospital Department of Pediatrics

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.

키워드

Extremely Low Birth Weight; Necrotizing Enterocolitis; Spontaneous Intestinal Perforation; Meconium Related Ileus; Meconium Non-Related Ileus; Abdominal Surgery
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