Document Detail


Liver hemorrhage during laparotomy in patients with necrotizing enterocolitis.
MedLine Citation:
PMID:  8863235     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Major liver hemorrhage (LH) without obvious iatrogenic injury was recently observed in several patients during operation for necrotizing enterocolitis (NEC). The purpose of this study was to determine the incidence and risk factors associated with the development of LH in patients with NEC. METHODS: The hospital charts of patients with NEC who underwent surgical exploration during a 5-year period (1989-1994) were reviewed. The patients in whom LH developed without obvious significant iatrogenic liver injury were compared with those who did not have LH. RESULTS: Eight of the 68 patients reviewed had LH. The survival rate for those with LH was 13%, compared with 88% for those without LH (P < .001). The patients with LH had a younger gestational age (28 +/- 3 weeks v 32 +/- 5 weeks) and a lower birth weight (1,262 +/- 489 g v 1,649 +/- 666 g); however, the differences were not significant. The patients with LH had significantly lower preoperative mean arterial blood pressure (35 +/- 1 mm Hg v 46 +/- 3 mm Hg; P < .001) and required greater fluid intake (272 +/- 28 mL/kg/d v 186 +/- 9 mL/kg/d; P < .01) for the 24 hours preceding surgery. CONCLUSION: LH is as an important and lethal complication associated with laparotomy in very small infants with NEC. The presence of hypotension and the administration of large amounts of volume in the preoperative period appear to be risk factors. Earlier surgical intervention and restoration of blood pressure using inotropic agents, once a particular level of fluid administration has been achieved, my be preventive.
Authors:
W E VanderKolk; P Kurz; J Daniels; B W Warner
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  31     ISSN:  0022-3468     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  1996 Aug 
Date Detail:
Created Date:  1997-01-14     Completed Date:  1997-01-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1063-6; discussion 1066-7     Citation Subset:  IM    
Affiliation:
Division of Pediatric Surgery, University of Cincinnati College of Medicine, OH, USA.
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MeSH Terms
Descriptor/Qualifier:
Birth Weight
Case-Control Studies
Enterocolitis, Pseudomembranous / surgery*
Fluid Therapy / adverse effects
Gestational Age
Hemorrhage / etiology*
Humans
Hypotension / etiology
Incidence
Infant, Newborn
Intraoperative Complications / etiology*
Liver Diseases / etiology*
Logistic Models
Risk Factors
Survival Analysis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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