Document Detail


The development of necrotizing enterocolitis following repair of gastroschisis: a surprisingly high incidence.
MedLine Citation:
PMID:  2976818     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We recently observed the development of necrotizing enterocolitis (NEC) in two consecutive newborn infants after gastroschisis repair. Because this association was unexpected, a retrospective review of our 11-year experience was performed using a multivariant computer analysis. The cohort consisted of 54 newborns with gastroschisis. All infants with omphalocele were excluded. Ten of 54 infants (18.5%) developed NEC as defined by classical clinical findings and pneumatosis intestinalis. Twenty-one distinct episodes of NEC occurred with up to three episodes (mean, 2.1) per patient. Twenty of the 21 episodes were successfully treated nonoperatively. Two infants developed pneumoperitoneum, one of whom underwent laparotomy upon which no perforation or intestinal infarction was found. Eight of the ten patients survived--a survival rate no different than for the remainder of the study group. Neither of the two deaths was attributable to NEC. The NEC was atypical in that no significant relationship was established with known predisposing conditions such as prematurity or low Apgar scores. Suspected risk factors such as time of feeding, type of closure, type of formula, total parenteral nutrition (TPN), and composition of TPN were not statistically related. Significant associations included concurrent TPN associated cholestatic liver disease in nine of the ten infants, antecedent intestinal surgery other than abdominal wall closure in five of the ten infants, and delay in initiation of enteral feedings (greater than 30 days) in eight of ten infants. In addition, the NEC occurred significantly later (range, 32 to 79 days; mean, 52 days) in the clinical course than usual; in fact, three of ten infants were rehospitalized with NEC following discharge. We conclude that a relationship exists between NEC and gastroschisis.(ABSTRACT TRUNCATED AT 250 WORDS)
Authors:
K T Oldham; A G Coran; R A Drongowski; P J Baker; J R Wesley; T Z Polley
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  23     ISSN:  0022-3468     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  1988 Oct 
Date Detail:
Created Date:  1989-05-10     Completed Date:  1989-05-10     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:  945-9     Citation Subset:  IM    
Affiliation:
Section of Pediatric Surgery, Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor.
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MeSH Terms
Descriptor/Qualifier:
Abdominal Muscles / abnormalities*,  surgery
Enterocolitis, Pseudomembranous / etiology*
Female
Humans
Infant, Newborn
Male
Postoperative Complications*
Retrospective Studies

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


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