Superior mesenteric artery flow velocity waveforms in small for gestational age fetuses.

The objective of this study was to analyze the superior mesenteric artery flow velocity waveforms in small-for-gestational-age fetuses and to compare its contribution in their management with that already provided by the middle cerebral artery and umbilical artery flow velocity waveforms. Middle cerebral artery, umbilical artery, and superior mesenteric artery flow velocity waveforms were prospectively obtained in 41 small-for-gestational-age fetuses with color Doppler ultrasonography. The pulsatility index was used to quantify the waveforms. Poor perinatal outcome was defined by cesarean section for fetal distress, perinatal death, need for assisted ventilation, and necrotizing enterocolitis. In the small-for-gestational age fetuses, the middle cerebral artery pulsatility index was abnormal in 22/41, the umbilical artery in 26/41, and the superior mesenteric artery in 17/41. Coincident with abnormal umbilical and middle cerebral artery flow velocity waveforms were greater occurrences of poor perinatal outcome. The abnormality of an increased pulsatility index in the superior mesenteric artery velocity waveforms of small-for-gestational-age fetuses suggests greater vascular resistance and an overall reduction in visceral perfusion. However, the study of the superior mesenteric artery only seemed to support the information already provided for by the middle cerebral and umbilical arteries.

Surgical conditions of the neonatal intestinal tract.

Many different pathophysiologic conditions can affect the neonatal intestinal tract and ultimately require surgical intervention. The symptomatology is primarily that of bowel dysfunction and obstruction. A thorough understanding of these disease processes is necessary of the managing physician. With this knowledge, a systematic course of resuscitation, evaluation, and treatment can be instituted, usually with predictably gratifying results for patient, family, and physician alike.

Factores perinatales de riesgo asociados a enterocolitis necrótica / Perinatal risk factors associated to necrotizing enterocolitis

Los factores de riesgo de enterocolitis necrotizante (ECN) continúan siendo de difícil apreciación. El objetivo de este estudio fue identificar cuáles eran las variables que se relacionaban con la aparición de la enfermedad en recién nacidos internados en una unidad de cuidado intensivo. Todos los neonatos con ECN (n:40) observados entre 1989 y 1994 fueron incluídos en este estudio caso-control. Las variables neonatales de cada recién nacido enfermo fueron comparadas con las de dos pacientes de similar edad gestacional, internados en la misma unidad y que no presentaran enterocolitis (grupo control n:76). Ambos grupos fueron similares en edad gestacional y peso al nacer. El grupo con ECN presentó una incidencia significativamente mayor de hipotermia neonatal (p<0.0005) y cateter arterial umbilical (p<0,05). El análisis de regresión logística mostró que las variables independientes asociadas en forma significativa con ECN fueron hipotermia (p<0,02; OR 3,1; IC 95 porciento: 1,3-6,9) y sepsis bacteriana (p<0,005); OR 4,9; IC 95 porciento: 2-12). No se hallaron diferencias significativas entre ambos grupos en otras variables estudiadas

Cirurgia de urgência no recém-nascido / Emergency surgery in the newborn

O tratamento cirúrgico das urgências neonatais exige recursos técnicos e humanos altamente especializados, e constitui importante segmento da Cirurgia Pediátrica. Dentre inúmeras afecçöes seräo abordadas, por sua incidência e gravidade, a atresia de esôfago, a hérnia diafragmática, as obstruçöes duodenais congênitas (atresia duodenal, pâncreas anual, a má-rotaçäo intestinal e membrana duodenal), as atresias jejuno-ileais, a doença de Hirschsprung, as anomalias ano-retais em suas várias formas, o íleo e a peritonite meconiais, a onfalocele, a gastrosquise e a enterite necrotizante neonatal. Aspectos clínicos e da fisiologia, bem como a conduta diagnóstica e os cuidados pré-, intra e pós operatórios säo analisados aqui, de maneira sucinta e objetiva

[Severe protracted intrauterine impaired perfusion--a cause of enteral motility disorder in the premature infant]. / Die schwere protrahierte intrauterine Perfusionsstörung--eine Ursache der enteralen Motilitätsstörung des Frühgeborenen.

The importance of measurement of blood flow in the fetal and uteroplacental circulations for the assessment of fetal wellbeing has been undisputed since some years. The present study is designed to prove if any relationship exists between severe hemodynamic disturbance in fetal as well as uteroplacental vessels and the occurrence of postnatal impairment of intestinal motility. The progress of 130 children, born in the University Women's Hospital Leipzig between 1991-1993 and with birth weights below 1500 g, has been analyzed. Doppler ultrasound examinations for detection of impairment in fetal and uteroplacental circulation were performed in all cases during pregnancy. A severe impairment of blood flow in the above mentioned circulations was defined by the presence of pathological pulsatility or resistance indices in both fetal and uteroplacental vessels as well as absent end diastolic flow in the umbilical artery and signs of centralization in the fetus. A severe hemodynamic impairment was found in 27 children and 26 of these were classified as severe hypotrophic after birth. The progress of these children was compared with this of other hypotrophic and euthrophic premature babies who had not revealed hemodynamic abnormalities. The incidence of disturbed postnatal intestinal motility (delayed meconium excretion, abdominal distention, retrograde peristalsis, subileus) was significantly higher in hypotrophic neonates with hemodynamic abnormalities in the course of pregnancy. Four of these newborns underwent surgery and surgical findings did not correlate with enterocolitis. The resumption of oral food intake for neonates who had hemodynamic impairments during pregnancy was delayed compared with the control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiology of necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) is a worldwide problem that has emerged in the past 25 years as the most common gastrointestinal emergency in neonatal intensive care units (NICU). In the United States the incidence ranges from 1 to 7.7% of NICU admissions. Ninety percent of the patients are premature infants. Mucosal injury, bacterial colonization and formula feeding are the three major pathogenetic factors that have been documented in most infants who have developed NEC. However, NEC may develop only if a threshold of injury, imposed by the coincidence of at least two of three events (intestinal ischemia, pathogenic bacteria, and excess of protein substrate) is exceeded. Immunological immaturity of the gut in premature babies may represent the crucial risk factor.

Necrotizing enterocolitis: a review of pathogenetic mechanisms and implications for prevention.

Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease of premature neonates that accounts for 3000 to 4000 deaths each year in the United States. The pathogenesis is not well understood, however theories suggest that prematurity, enteral feeding, bacterial colonization, and intestinal ischemia contribute to the intestinal injury. Furthermore, recent studies have shown that platelet activating factor and perhaps other inflammatory mediators mediate bowel necrosis in animals and possibly in humans. Although no specific intervention for NEC treatment exists, preventive therapy using either enteral IgA supplementation, breast milk feeding, antibiotic prophylaxis, or exogenous steroid administration have reduced the incidence of this overwhelming disease in small randomized trials. These modalities and perhaps PAF antagonists or other inflammatory mediator inhibitors may reduce the incidence or severity of NEC in the next several years.

[A rare cause of neonatal ulcero-necrotizing enterocolitis: aortic coarctation syndrome]. / Une cause rare d'entérocolite ulcéro-nécrosante néo-natale: le syndrome de coarctation aortique.

The authors report a case of necrotizing enterocolitis which appeared in the first hours of life of a full-term neonate without signs of sepsis. This neonate presented with a severe hypoplasia of the horizontal aorta and very tight coarctation responsible for hepatic, renal and mesenteric ischemia. Reports of enterocolitis as a complication of congenital heart disease are rare and related most often to hypoplastic left heart than to coarctation of the aorta.

Mild form of neonatal necrotizing enterocolitis masked by anal fissures.

In three infants with clinically mild necrotizing enterocolitis, heme-positive stools were initially attributed to anal fissures, delaying diagnosis and treatment of the enterocolitis for 4-10 days. Radiographically, pneumatosis intestinalis involved the entire colon and rectum. A causal relation may exist between necrotizing enterocolitis and anal fissure.