RESUMO
BACKGROUND: We aim to determine clinical risk factors for postoperative complications in preterm infants with surgical necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP). METHODS: A retrospective cohort study of preterm infants with surgical NEC or SIP to compare clinical factors between those with and without postoperative complications. RESULTS: 78/109 (71.5%) infants had any complication following surgical NEC. Adhesions (20/35, 57.1%) and wound infection (6/35, 17.1%) were the most common single surgical complications. Patients with a single surgical complication (35/66, 53%) were significantly less likely to be exposed to antenatal steroids, more frequently had a jejunostomy, needed a central line longer, and had a longer length of stay than those without any surgical complication. Infants with >â1 surgical complication (43/71, 60.5%) included mainly females, and had AKI more frequently at NEC onset, lower weight z-scores and lower weight for length z- scores at 36 weeks PMA than those without any complications.On multinomial logistic regression, antenatal steroids exposure (OR 0.23 [CI 0.06, 0.84]; pâ=â0.027) was independently associated with lower risk and jejunostomy 4.81 (1.29, 17.9) was independently associated with higher risk of developing a single complication. AKI following disease onset (OR 5.33 (1.38, 20.6), Pâ=â0.015) was independently associated with >â1 complication in surgical NEC/SIP infants. CONCLUSION: Infants with postoperative complications following surgical NEC were more likely to be female, have additional morbidities, and demonstrate growth failure at 36 weeks PMA than those without surgical complications. There was no difference in mortality between those with and without surgical complications.
Assuntos
Injúria Renal Aguda , Enterocolite Necrosante , Doenças do Recém-Nascido , Perfuração Intestinal , Gravidez , Lactente , Recém-Nascido , Humanos , Feminino , Masculino , Recém-Nascido Prematuro , Estudos Retrospectivos , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/cirurgia , Fatores de Risco , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Complicações Pós-Operatórias/epidemiologia , EsteroidesRESUMO
OBJECTIVE: We sought to investigate the clinical determinants of intestinal failure and death in preterm infants with surgical NEC. METHODS: Retrospective comparison of clinical information between Group Aâ=âintestinal failure (Parenteral nutrition (PN) >90 days) and death and Group Bâ=âsurvivors and with PN dependenceâ<â90 days in preterm infants with surgical NEC. RESULTS: Group A (nâ=â99/143) had a lower mean gestational age (26.4 weeks [SD3.5] vs. 29.4 [SD 3.5]; pâ=â0.013), lower birth weight (873 gm [SD 427g] vs. 1425 gm [894g]; pâ=â<0.001), later age of NEC onset (22 days [SD20] vs. 16 days [SD 17]; pâ=â0.128), received surgery later (276 hours [SD 544] vs. 117 hours [SD 267]; pâ=â0.032), had cholestasis, received dopamine (80.6% vs. 58.5%; pâ=â0.010) more frequently and had longer postoperative ileus time (19.8 days [SD 15.4] vs. 11.8 days [SD 6.5]; pâ=â<0.001) and reached full feeds later (93 days [SD 45] vs. 44 [SD 22]; pâ=â<0.001) than Group B.On multivariate logistic regression, higher birth weight was associated with lower risk (OR 0.35, 95% CI 0.15-0.82; pâ=â0.016) of TPNâ>â90 days or death. Longer length of bowel resected (OR 1.76, 95% CI 1.02-3.02; pâ=â0.039) and longer postoperative ileus (OR 2.87, 95% CI 1.26-6.53; pâ=â0.011) were also independently associated with TPN >90days or death adjusted for gestational age and antenatal steroid treatment. CONCLUSION: In preterm infants with surgical NEC, clinical factors such as lower birth weight, longer bowel loss, and postoperative ileus days were significantly and independently associated with TPN >90 days or death.
Assuntos
Enterocolite Necrosante , Íleus , Doenças do Recém-Nascido , Insuficiência Intestinal , Gravidez , Lactente , Recém-Nascido , Feminino , Humanos , Recém-Nascido Prematuro , Peso ao Nascer , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/cirurgia , Estudos Retrospectivos , Íleus/epidemiologiaRESUMO
BACKGROUND: To determine the association of placental pathologic lesions with postoperative outcomes, survival, and white matter injury (WMI) in preterm infants with NEC. METHODS: A retrospective chart review of 107 neonates with NEC (Bell stageâ>âIIa) from Jan 2013- June 2020 was completed. Demographic, clinical, and outcome data were compared between infants with or without placental pathologic lesions. RESULTS: In this cohort, 59/107 (55%) infants had medical NEC, and 48 (45%) had surgical NEC. The infants had a mean gestational age of 28.1±3.7 weeks and a birth weight of 1103±647 g. Maternal vascular malperfusion (82/107, 76.6%) and acute histological chorioamnionitis (42, 39.3%) were the most common pathological placental lesions. Acute histologic chorioamnionitis with fetal inflammatory response was more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; pâ=â0.02). The NEC Infants with WMI on brain MRI scans had a significantly higher incidence of acute histological chorioamnionitis (52% vs. 27.8%; Pâ=â0.04). No significant differences in mortality, length of stay and postoperative outcomes in neonates with and without acute histologic chorioamnionitis with fetal inflammatory response were noted. On unadjusted logistic regression, acute histologic chorioamnionitis without fetal inflammatory response was also associated with higher odds of WMI (OR 2.81; 95% CI 1.05-7.54; pâ=â0.039). CONCLUSION: Acute histological chorioamnionitis without fetal inflammatory response was associated with higher odds of WMI in infants with NEC, with no significant impact on mortality and other postoperative outcomes.
Assuntos
Lesões Encefálicas , Corioamnionite , Enterocolite Necrosante , Doenças Fetais , Doenças do Recém-Nascido , Substância Branca , Lactente , Recém-Nascido , Humanos , Feminino , Gravidez , Recém-Nascido Prematuro , Placenta/patologia , Corioamnionite/epidemiologia , Corioamnionite/patologia , Estudos Retrospectivos , Substância Branca/diagnóstico por imagem , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/cirurgia , Enterocolite Necrosante/etiologia , Lesões Encefálicas/complicaçõesRESUMO
BACKGROUND: To determine the clinical implications and gestation age-specific diagnostic predictability of pneumatosis in preterm infants with necrotizing enterocolitis (NEC). METHODS: A retrospective study on abdominal radiographs comparing clinical and radiological information in infants with and without pneumatosis. RESULT: Our findings disproved our hypothesis. Pneumatosis was seen more frequently in infants with higher gestational age [28.4 (26.1-32.4) vs. 26.4 (24.3-29) weeks; pâ<â0.001] and birth weight [1110 (762-1768) vs. 770 (645-1022) grams; pâ<â0.001] and were more likely delivered vaginally (39.1% vs. 21.7%, pâ=â0.01). Portal venous gas was seen frequently on radiographs (10.3% vs. 0%, pâ<â0.001), but not pneumoperitoneum (20.7% vs. 36.7%, pâ=â0.02). Infants with pneumatosis frequently developed acute kidney injury, with higher serum creatinine (16.5% vs. 4.5%, pâ=â0.02) and frequent oliguria (12.9% vs. 2.7 %; pâ=â0.043) and had higher C-reactive protein levels at 24 and 96 hours (pâ<â0.002). Receiver operating curves for pneumatosis showed GA >28 weeks and birth weight >â1000âgm to have a sensitivity of 58.6% and specificity of 72.5%. CONCLUSION: Contrary to our hypothesis, infants who developed pneumatosis during NEC were more mature with a higher gestational age and birth weight than those who did not.