Laparoscopy to Assist Surgical Decisions Related to Necrotizing Enterocolitis in Preterm Neonates

Laparoscopy for Gastrointestinal Perforation in Neonates: A New Animal Model for Training

Background: Gastrointestinal (GI) perforation in the neonatal period can result from different conditions with varying degrees of severity. Optimal timing for surgery is challenging to establish and laparoscopy has been proposed as a diagnostic tool to minimize surgical delays and refine surgical indications. However, no standard animal model is universally accepted for training laparoscopic management of neonatal GI perforations. We aimed to define a small-sized animal model and (1) assess the effectiveness of laparoscopy in identifying GI perforations and (2) evaluate the viability of intracorporeal suturing, in a confined working space. Methods: In total, 30 Sprague Dawley rats underwent laparoscopy. In Part I, a random GI perforation was performed. In Part II, the perforation was identified and sutured. The surgeon of Part II remained blinded during Part I. The suture line was assessed for leaks and strictures once the rats were euthanized. Results: In Part I, 29 perforations were created: 22 in the ileum, 3 in the colon, 2 in the jejunum, 1 in the stomach, and 1 in the duodenum. In one rat, the GI tract was left intact. In Part II, all 29 perforations were identified and sutured. The average duration of Part II was 53 ± 16 minutes. During suture evaluation, a leak was observed in two cases, and a stricture in two additional cases. Conclusions: Laparoscopy was technically feasible and highly sensitive in detecting isolated GI perforation in a rat model. This model holds particular value for training laparoscopic skills in a space-limited setting. Further investigation is needed to see if a learning curve can be achieved.

Preterm pigs for preterm birth research: reasonably feasible

Preterm birth will disrupt the pattern and course of organ development, which may result in morbidity and mortality of newborn infants. Large animal models are crucial resources for developing novel, credible, and effective treatments for preterm infants. This review summarizes the classification, definition, and prevalence of preterm birth, and analyzes the relationship between the predicted animal days and one human year in the most widely used animal models (mice, rats, rabbits, sheep, and pigs) for preterm birth studies. After that, the physiological characteristics of preterm pig models at different gestational ages are described in more detail, including birth weight, body temperature, brain development, cardiovascular system development, respiratory, digestive, and immune system development, kidney development, and blood constituents. Studies on postnatal development and adaptation of preterm pig models of different gestational ages will help to determine the physiological basis for survival and development of very preterm, middle preterm, and late preterm newborns, and will also aid in the study and accurate optimization of feeding conditions, diet- or drug-related interventions for preterm neonates. Finally, this review summarizes several accepted pediatric applications of preterm pig models in nutritional fortification, necrotizing enterocolitis, neonatal encephalopathy and hypothermia intervention, mechanical ventilation, and oxygen therapy for preterm infants.

Early laparoscopic-assisted surgery is associated with decreased post-operative inflammation and intestinal strictures in infants with necrotizing enterocolitis

INTRODUCTION

In 2015, a protocol including early laparoscopy-assisted surgery in the treatment of necrotizing enterocolitis (NEC) was implemented at our institution. Carbon dioxide insufflation during laparoscopy may have an anti-inflammatory effect. We aimed to compare post-operative outcome after early laparoscopy-assisted surgery and classical laparotomy for NEC.

MATERIAL AND METHODS

Charts of premature infants undergoing surgery for NEC (2012-2021) were reviewed. Cases operated by early laparoscopy-assisted surgery (2015-2021) were compared to infants operated for NEC between 2012 and 2015 (laparotomy-NEC). Outcomes were post-operative CRP, need for reintervention, mortality, and the occurrence of post-NEC intestinal strictures. CRP was measured on the day of surgery (POD-0), 2 days (POD-2), and 7 days after surgery (POD-7). Data were compared using contingency tables for categorical variables and Student t-test or Mann-Whitney test for continuous variables.

RESULTS

Infants with NEC operated by early laparoscopy (n = 48) and laparotomy (n = 29) were similar in terms of perforation (60% vs 58%, p = 0.99) and POD-0 CRP (139 vs 124 mg/L, p = 0.94). Delay between first signs of NEC and surgery was shorter in the laparoscopy group (3 vs 6 days, p = 0.004). Early laparoscopy was associated with a lower CRP on POD-2 (108 vs 170, p = 0.005) and POD-7 (37 vs 68, p = 0.002), as well as a lower rate of post-operative intestinal stricture (34% vs 61%, p = 0.04).

CONCLUSIONS

In addition to being safe and feasible in premature infants, early laparoscopic-assisted surgery was associated with decreased NEC-related post-operative inflammation and strictures. A prospective, randomized study is needed in order to evaluate short and long-term effects of laparoscopy in infants with NEC.

LEVEL OF EVIDENCE

Level III.

Clinical Spectrum and Outcomes of Neonatal Necrotizing Enterocolitis

BACKGROUND/AIM

The objective of the study was analysis of risk factors associated with outcome of necrotizing enterocolitis (NEC) in infants in a single-center study.

PATIENTS AND METHODS

All consecutive infants hospitalized for NEC over a period of 6 years were retrospectively analyzed for clinical course, infections, treatment and outcome.

RESULTS

Out of 76 patients, surgical management was applied in 56 (53 exploratory laparotomy, three initial peritoneal drain placement) and in 20 there was only a conservative approach. Segmental intestinal resection was performed in 41 patients. Survival from NEC in our cohort was 79%. We found that independent adverse risk factors of outcome of newborns and infants with NEC were gut perforation, infection, abdominal wall erythema, and development of acute kidney injury.

CONCLUSION

We underline the value of both surgical and conservative approach with careful management in this cohort of patients.