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Kimoto Y, Hirata K, Nozaki M, Mochizuki N, Hirano S, Wada K. Postneonatal mortality of severely small for gestational age extremely low birth weight infants. Pediatr Neonatol 2024; 65:165-169. [PMID: 37741757 DOI: 10.1016/j.pedneo.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Infants born with weights below the 10th percentile of the expected birth weight for gestational age, defined as small for gestational age (SGA), have an increased risk of neonatal mortality and prematurity-related complications. However, the relationship between SGA and postneonatal (28 days to <1 year) mortality among extremely low birth weight infants (ELBWIs) remains uncertain. Hence, this study aimed to investigate the association between birth weight percentiles and postneonatal mortality in ELBWIs. METHODS A cohort of ELBWIs with a gestational age greater than 23 weeks who were admitted to Osaka Women's and Children's Hospital between 2008 and 2019 were considered eligible. Infants with major congenital anomalies, those large for their gestational age, or those who died within 28 days of birth were excluded. Baseline characteristics and outcomes of the three groups of ELBWIs-severe SGA (sSGA; birth weight, <3rd percentile), moderate SGA (mSGA; birth weight, 3rd to <10th percentile), and appropriate for gestational age (AGA; birth weight, 10th to <90th percentile)-were compared. Logistic regression analysis was used to identify perinatal factors associated with postneonatal mortality in sSGA infants. RESULTS sSGA ELBWIs demonstrated higher incidence of meconium obstruction (25% vs. 8.3% vs. 7.6%, P < 0.001), cholestasis (21% vs. 4.2% vs. 9.7%, P < 0.003), and postneonatal mortality (7.3% vs. 0% vs. 0.7%, P < 0.004) than mSGA and AGA ELBWIs. In the logistic regression analysis, cholestasis (odds ratio, 30.1; 95% confidence interval, 2.98-304) and sepsis (odds ratio, 13.5; 95% confidence interval, 1.06-173) were significantly related to postneonatal mortality among ELBWIs with sSGA. The leading cause of postneonatal mortality in sSGA ELBWIs was liver failure (55.5%). CONCLUSION sSGA ELBWIs exhibited a higher rate of postneonatal mortality compared to mSGA and AGA ELBWIs. Therefore, strategies aimed at preventing liver dysfunction in severely cholestatic ELBWIs with sSGA are necessary.
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Affiliation(s)
- Yasuka Kimoto
- Departments of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Katsuya Hirata
- Departments of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan.
| | - Masatoshi Nozaki
- Departments of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Narutaka Mochizuki
- Departments of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Shinya Hirano
- Departments of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Kazuko Wada
- Departments of Neonatal Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
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Clinical and growth outcomes after meconium-related ileus improved with Gastrografin enema in very low birth weight infants. PLoS One 2022; 17:e0272915. [PMID: 35951504 PMCID: PMC9371358 DOI: 10.1371/journal.pone.0272915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/28/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Meconium-related ileus in very low birth weight infants can lead to increased morbidity or mortality and prolonged hospitalization without prompt diagnosis and treatment. This study primarily aimed to identify the incidence of and factors associated with meconium-related ileus and secondarily sought to investigate clinical and growth outcomes after water-soluble contrast media (Gastrografin) enema.
Methods
We retrospectively reviewed medical records of very low birth weight infants born between February 2009 and March 2019 in the neonatal intensive care unit of a single medical center. Perinatal factors, clinical outcomes, and growth outcomes were compared between the group with meconium-related ileus that received Gastrografin enema and the control group.
Results
Twenty-four (6.9%) patients were diagnosed with meconium-related ileus among 347 very low birth weight infants. All achieved successful evacuation of meconium with an average of 2.8 (range: 1–8) Gastrografin enema attempts without procedure-related complications. Initiation of Gastrografin enema was performed at mean 7.0 days (range: 2–16) after birth. Incidences of moderate to severe bronchopulmonary dysplasia were higher and the duration of mechanical ventilation and need for oxygen were longer in the meconium-related ileus group (P = 0.039, 0.046, 0.048, respectively). Meconium-related ileus infants took more time to start enteral feeding and the nothing per oral time was longer (P = 0.001 and 0.018, respectively). However, time to achieve full enteral feeding and Z-scores for weight and height at 37 weeks and at 6 months corrected age did not differ between the two groups.
Conclusions
Gastrografin enema in very low birth weight infants with meconium-related ileus was an effective and safe medical management. Following Gastrografin enema, very low birth weight infants with meconium-related ileus achieved similar subsequent feeding progress and similar growth levels as the control groups without meconium-related ileus.
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Mitani Y, Kubota A, Goda T, Kato H, Watanabe T, Riko M, Tsuno Y, Kumagai T, Yamaue H. Optimum therapeutic strategy for meconium-related ileus in very-low-birth-weight infants. J Pediatr Surg 2021; 56:1117-1120. [PMID: 33896618 DOI: 10.1016/j.jpedsurg.2021.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND/PURPOSE therapeutic strategy for meconium-related ileus (MRI) in very-low-birth-weight infants (VLBWs) has not been established. This study aims to clarify the optimum therapeutic strategy for MRI in VLBWs. METHODS MRI was defined as delayed meconium excretion and microcolon on contrast enema with Gastrografin (diatrizoate acid). Forty-two infants with MRI were treated at our institution between 2009 and 2019, and are reviewed here. They were classified into two groups: in group A (n=21), Gastrografin regurgitated into the dilated intestine during the first or second round of Gastrografin enema (GaE), while in group B (N = 21), Gastrografin did not regurgitate. Laparotomy was indicated if the intestine was perforated, or if abdominal distention was not relieved by two rounds of GaE. RESULTS in group A, meconium was excreted in all cases within 24 h after GaE, and no cases required laparotomy. In group B, twelve cases (57%) underwent laparotomy (P < 0.01), six cases in this group (29%), showed free air on X-ray images (P < 0.01). The median hospital stay in groups A and B were 89.0 and 136.5 days, respectively (P < 0.05). Overall mortality was 2.4%. CONCLUSIONS early therapeutic diagnosis by GaE followed by early surgery is suggested as the optimum strategy for MRI in VLBWs.
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Affiliation(s)
- Yasuyuki Mitani
- Second Department of Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Akio Kubota
- Second Department of Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Taro Goda
- Second Department of Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Hirotaka Kato
- Second Department of Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Takashi Watanabe
- Second Department of Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Mitsuhiko Riko
- Neonatology, Maternal and Perinatal Care Center, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Yoshinobu Tsuno
- Neonatology, Maternal and Perinatal Care Center, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Takeshi Kumagai
- Neonatology, Maternal and Perinatal Care Center, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan.
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Muto M, Sugita K, Ibara S, Masuya R, Matuskubo M, Kawano T, Saruwatari Y, Machigashira S, Sakamoto K, Nakame K, Shinyama S, Torikai M, Hayashida Y, Mukai M, Ikee T, Shimono R, Noguchi H, Ieiri S. Discrepancy between the survival rate and neuropsychological development in postsurgical extremely low-birth-weight infants: a retrospective study over two decades at a single institution. Pediatr Surg Int 2021; 37:411-417. [PMID: 33427921 DOI: 10.1007/s00383-020-04825-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI) are major diseases that cause gastrointestinal disorders in extremely low-birth-weight infants (ELBWIs). We conducted a review to compare the postoperative outcomes of ELBWIs with these diseases in our neonatal intensive-care unit. METHODS A retrospective chart review of ELBWIs surgically treated for NEC (n = 31), FIP (n = 35), and MRI (n = 16) in 2001-2018 was undertaken. This period was divided into early (2001-2005), middle (2006-2010), and late (2011-2018) periods. Data were analyzed with the Cochran-Armitage test. Statistical significance was defined as p < 0.05. RESULTS The survival rates in ELBWIs with NEC (early/middle/late: 36.4%/42.9%/61.5%; p = 0.212) and FIP (20%/50%/70.6%; p = 0.012) improved over time; all patients with MRI survived. The neuropsychological development of 24 cases was assessed with the Kyoto Scale of Psychological Development in the Postural-Motor, Cognitive-Adaptative, and Language-Social domains. The mean developmental quotient of all domains was 68.4 (range 18-95) at corrected 1.5 years of age and 69.1 (range 25-108) at chronological 3 years of age, both were considered as poor development. There was no improvement over time (p = 0.899). CONCLUSION Ideal neuropsychological development was not observed with the improvement of survival rate. Less-invasive surgical intervention and adequate postoperative care are required to encourage further development.
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Affiliation(s)
- Mitsuru Muto
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, 890-8520, Japan.
| | - Koshiro Sugita
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, 890-8520, Japan
| | - Satoshi Ibara
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Ryuta Masuya
- Department of Surgery, University of Miyazaki Hospital, Miyazaki, Japan
| | - Makoto Matuskubo
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, 890-8520, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | | | - Seiro Machigashira
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Koichi Sakamoto
- Department of Pediatric Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Kazuhiko Nakame
- Department of Surgery, University of Miyazaki Hospital, Miyazaki, Japan
| | - Shin Shinyama
- Department of Pediatric Surgery, Kitakyushu City Yahata Hospital, Fukuoka, Japan
| | - Motofumi Torikai
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Yoshihiro Hayashida
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, 890-8520, Japan
| | - Motoi Mukai
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, 890-8520, Japan
| | - Takamasa Ikee
- Department of Pediatric Surgery, Saiseikai Sendai Hospital, Kagoshima, Japan
| | - Ryuichi Shimono
- Department of Pediatric Surgery, Kagawa University Hospital, Kagawa, Japan
| | - Hiroyuki Noguchi
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
- Nanmeikai Miyagami Hospital, Kagoshima, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, 890-8520, Japan
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5
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Hong HS, Kim SS, Park GY. Oral Administration of Nonionic Water-Soluble Contrast Media to Treat Meconium Obstruction in Premature Infants: A Preliminary Study. NEONATAL MEDICINE 2021. [DOI: 10.5385/nm.2021.28.1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Yokoyama S, Nakaoka T, Nukada T, Ikeda Y, Hara S. Meconium-related ileus mimicking ileal atresia in a full-term neonate. Pediatr Int 2021; 63:229-231. [PMID: 33529482 DOI: 10.1111/ped.14531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/27/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Satoshi Yokoyama
- Department of Pediatric Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Tatsuo Nakaoka
- Department of Pediatric Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Takayuki Nukada
- Department of Pediatrics, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Yuka Ikeda
- Department of Pediatrics, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Shigeto Hara
- Department of Pediatrics, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
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Kurimoto T, Ibara S, Kamitomo M, Tokuhisa T, Maeda T, Maede Y, Ishihara C, Naito Y, Hirakawa E, Yamamoto T, Yamamoto M, Kibe M, Takayama T, Ohashi H. Risk Factors for Mortality and Neurodevelopmental Impairment among Neonates Born at 22-23 Weeks' Gestation. Neonatology 2021; 118:310-316. [PMID: 33744873 DOI: 10.1159/000514161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to evaluate the risk factors for mortality and neurodevelopmental impairment (NDI) among infants of 22-23 weeks' gestational age, which currently remain unclear. METHODS This retrospective case-control study included 104 infants delivered at 22-23 weeks' gestation at Kagoshima City Hospital from 2006 to 2015. We compared 65 and 34 cases of survival to discharge and postnatal in-hospital death (5 excluded), respectively, and 26 and 35 cases with and without NDI, respectively, using maternal, prenatal, and postnatal records. A high rate of survivors' follow-up (61/65) was achieved in this study. RESULTS The survival rate was 75.0% (21/28) and 62.0% (44/71) among infants born at 22 and 23 weeks' gestation, respectively. Infants who died weighed less (525.5 vs. 578 g, p = 0.04) and their intrauterine growth retardation (IUGR) rate (<5th percentile) was higher (14.7 vs. 1.5%, p = 0.02). Mortality was associated with an increased incidence of bradycardia on fetal heart rate monitoring (11.8 vs. 1.5%, p = 0.046), periventricular hemorrhagic infarction (PVHI; 32.4 vs. 6.2%, p = 0.001), necrotizing enterocolitis (NEC, surgery or drain tube; 14.7 vs. 0.0%, p = 0.004), and tension pneumothorax (29.4 vs. 6.2%, p = 0.004). There were significant differences in the proportion of PVHI (15.4 vs. 0%, p = 0.03) between infants with and without NDI. CONCLUSIONS IUGR, bradycardia, PVHI, NEC, and tension pneumothorax were associated with neonatal mortality among infants born at 22-23 weeks' gestation. NDI at 36-42 months' chronological age was associated with PVHI.
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Affiliation(s)
- Tomonori Kurimoto
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan,
| | - Satoshi Ibara
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Masato Kamitomo
- Department of Obstetrics and Gynecology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Takuya Tokuhisa
- Department of Neonatology, Perinatal Medical Center, Imakiire General Hospital, Kagoshima, Japan
| | - Takatsugu Maeda
- Department of Obstetrics and Gynecology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Yoshinobu Maede
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Chie Ishihara
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Yoshiki Naito
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Eiji Hirakawa
- Department of Neonatology, Perinatal Medical Center, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Tsuyoshi Yamamoto
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Masakatsu Yamamoto
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Masaya Kibe
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
| | - Tatsu Takayama
- Department of Neonatology, Perinatal Medical Center, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Hiroshi Ohashi
- Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan
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Torikai M, Sugita K, Ibara S, Ishihara C, Kibe M, Murakami K, Shinyama S, Mukai M, Ikee T, Sueyoshi K, Noguchi H, Ieiri S. Prophylactic efficacy of enteral antifungal administration of miconazole for intestinal perforation, especially for necrotizing enterocolitis: a historical cohort study at a single institution. Surg Today 2020; 51:568-574. [PMID: 32886209 DOI: 10.1007/s00595-020-02125-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Despite improvements in neonatal intensive care, the outcomes of extremely-low-birth-weight infants (ELBWIs) with surgical diseases remain to be improved. We started administering enteral miconazole (MCZ) to ELBWIs from 2002 to prevent fungal infection. Since then, the incidence of intestinal perforation has significantly decreased. We investigated this prophylactic effect of MCZ against necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) and explored a new prophylactic concept against intestinal perforation. METHODS We designed a historical cohort study to evaluate the effect of MCZ for intestinal perforation in ELBWIs who underwent treatment in our neonatal intensive-care unit between January 1998 and December 2005. We divided these cases into two groups: the Pre-MCZ group and the Post-MCZ group. We compared the morbidity, clinical outcomes and pathological features of NEC and FIP. RESULTS The rate of intestinal perforation with NEC was significantly reduced after the introduction of MCZ (p = 0.007, odds ratio; 3.782, 95% confidence interval; 1.368-12.08). The pathological findings of NEC specimens showed that the accumulation of inflammatory cells was significantly reduced in the Post-MCZ group when compared with the Pre-MCZ group (p < 0.05). CONCLUSIONS The efficacy of the enteral administration of MCZ on intestinal perforation with NEC highlights a new prophylactic concept in the clinical management of ELBWIs.
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Affiliation(s)
- Motofumi Torikai
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan.,Department of Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| | - Koshiro Sugita
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan.,Department of Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| | - Satoshi Ibara
- Department of Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| | - Chie Ishihara
- Department of Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| | - Masaya Kibe
- Department of Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| | - Kenichi Murakami
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan.,Department of Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| | - Shin Shinyama
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan.,Department of Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| | - Motoi Mukai
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan.,Department of Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| | - Takamasa Ikee
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan.,Department of Neonatology, Kagoshima City Hospital, Kagoshima, Japan
| | - Kazunobu Sueyoshi
- Department of Clinical Pathology, Kagoshima City Hospital, Kagoshima, Japan
| | - Hiroyuki Noguchi
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan.
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Byun J, Han JW, Youn JK, Yang HB, Shin SH, Kim EK, Kim HY, Jung SE. Risk factors of meconium-related ileus in very low birth weight infants: patients-control study. Sci Rep 2020; 10:4674. [PMID: 32170203 PMCID: PMC7070079 DOI: 10.1038/s41598-020-60016-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/06/2020] [Indexed: 01/07/2023] Open
Abstract
Very low birth weight (VLBW) neonates experience various problems, including meconium-related ileus (MRI). This study investigated the risk factors of MRI and surgical MRI in VLBW infants. VLBW neonates admitted to the Neonatal Intensive Care Unit of Seoul National University Children's Hospital from October 2002 to September 2016 were included in the study. The diagnostic criteria for MRI were a decreased frequency of defecation with intolerable feeding, vomiting, and increased gastric residue (>50%); meconium-filled bowel dilatation in an imaging study; and no evidence of necrotizing enteritis or spontaneous intestinal perforation. Medical MRIs and surgical MRIs were managed through conventional treatment and surgical intervention. Of 1543 neonates, 69 and 1474 were in the patient and control groups, respectively. The risk factors for MRI include low birth weight (BW), cesarean section delivery, fetal distress, maternal diabetes, maternal hypertension, and maternal steroid use. Low BW and fetal distress were independent risk factors for MRI. Compared to the medical MRI group (n = 44), the risk factors for surgical MRI (n = 25) included males, younger gestational age, low BW, and meconium located at the small bowel. Male gender and low BW were independent risk factors for surgical MRI. Low BW and fetal distress were independent risk factors for MRI and male gender and low BW were independent risk factors for surgical MRI. In VLBW neonates, careful attention to the risk factors for MRI could minimize or avoid surgical interventions.
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Affiliation(s)
- Jeik Byun
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ji-Won Han
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Joong Kee Youn
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hee-Beom Yang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Sung-Eun Jung
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Arimitsu T, Wakabayashi D, Tamaoka S, Takahashi M, Hida M, Takahashi T. Case Report: Intact Survival of a Marginally Viable Male Infant Born Weighing 268 Grams at 24 Weeks Gestation. Front Pediatr 2020; 8:628362. [PMID: 33614546 PMCID: PMC7888275 DOI: 10.3389/fped.2020.628362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/23/2020] [Indexed: 11/17/2022] Open
Abstract
We report the case of a preterm small for gestational age male infant born at 24 weeks of gestation with a birth weight of 268 g who was discharged from our hospital without the requirement for home oxygen therapy or tube feeding. He did not experience severe intraventricular hemorrhage, periventricular leukomalacia, hearing disability, or any other serious complications. At that time (February 2019), according to the University of Iowa's Tiniest Babies Registry, he was the tiniest male infant in the world to survive without any serious complications other than severe retinopathy of prematurity that required laser therapy. Although the survival rate of infants with extremely low birth weight is improving worldwide, a high mortality rate and incidence of severe complications remain common for infants weighing <300 g at birth, particularly in male infants. In recent years, there have been frequent discussions regarding the ethical and social issues involved in treating extremely preterm infants weighing <400 g. Despite the challenges, reports of such infants surviving are increasing. Neonatal medicine has already achieved great success in treating infants weighing 400 g or more at birth. However, lack of evidence and experience may make physicians reluctant to treat infants weighing less than this. The present case demonstrates that intact survival of a marginally viable male infant with a birth weight of <300 g is possible with minimal handling and family involvement beginning shortly after birth. Our detailed description of the clinical course of this case should provide invaluable information to physicians around the world who treat such infants. This report will aid in the progress of neonatal medicine and help to address many of the social and ethical issues surrounding their care.
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Affiliation(s)
- Takeshi Arimitsu
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Daiki Wakabayashi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Tamaoka
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Mona Takahashi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Mariko Hida
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Takao Takahashi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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11
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Pellegrino C, Molinaro F, Ferrara F, Bindi E, Fusi G, Messina M, Angotti R. Meconium-related ileum in preterm and low birth weight children. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04914-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Safety and efficacy of mucous fistula refeeding in low-birth-weight infants with enterostomies. Pediatr Surg Int 2019; 35:1101-1107. [PMID: 31396740 DOI: 10.1007/s00383-019-04533-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the safety and efficacy of mucous fistula refeeding (MFR) in low-birth-weight infants. METHODS Between December 2006 and December 2018, medical records of low-birth-weight infants who underwent small bowel enterostomy formation in the neonatal period and subsequent stoma closure at our institution were retrospectively reviewed. Patients were assigned to "refeeding" (RF) and "non-refeeding" (NRF) groups, which were compared for patient characteristics and clinical outcomes. We also cultured the proximal stoma output over time in the RF group and reviewed changes in the flora to evaluate the safety of refeeding. RESULTS In the RF group, compared with that before refeeding, there was significantly more rapid weight gain after refeeding (17.7 vs 10.6 g/day; P = 0.002). Median total time of parenteral nutrition (PN) was 25 and 87 days in the RF and NRF groups, respectively (P = 0.001). The number of patients who developed PN-associated liver disease (PNALD) was smaller in the RF group (P = 0.12). No complications of MFR were noted and no pathogenic bacteria were cultured. CONCLUSION MFR was able to diminish the need for PN, which potentially decreased the incidence of PNALD, and was safe as there were no complications of the refeeding process.
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13
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Byun J, Kim HY, Jung SE, Yang HB, Kim EK, Shin SH, Kim HS. Comparison of Acute Abdominal Surgical Outcomes of Extremely-Low-Birth-Weight Neonates according to Differential Diagnosis. J Korean Med Sci 2019; 34:e222. [PMID: 31496138 PMCID: PMC6732259 DOI: 10.3346/jkms.2019.34.e222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/26/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Improvements in perinatal intensive care have improved survival of extremely-low-birth-weight (ELBW) neonates, although the risk of acute abdomen has increased. The differential diagnosis resulting in abdominal surgery can be categorized into necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP), meconium-related ileus (MRI), and meconium non-related ileus (MNRI). The purpose of this study was to review our experience with abdominal surgery for ELBW neonates, and to evaluate characteristics and prognosis according to the differential diagnosis. METHODS Medical records of ELBW neonates treated between 2003 and 2015 were retrospectively reviewed. RESULTS Of 805 ELBW neonates, 65 (8.1%) received abdominal surgery. The numbers of cases by disease category were 29 for NEC, 18 for SIP, 13 for MRI, and 5 for MNRI. Ostoma formation was performed in 61 (93.8%) patients; primary anastomosis without ostoma was performed in 4 (6.2%). All patients without ostoma formation experienced re-perforation of the anastomosis site. Seven patients had 30-day postoperative mortality (6 had NEC). Long-term survival of the surgical and non-surgical groups was not statistically different. NEC was a poor prognostic factor for survival outcome (P = 0.033). CONCLUSION Abdominal surgery for ELBW neonates is feasible. Ostoma formation can lead to reduced complications compared to primary anastomosis.
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Affiliation(s)
- Jeik Byun
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Young Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Sung Eun Jung
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Beom Yang
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ee Kyung Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han Suk Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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Woods JD, Payton KSE, Sanchez-Lara PA, Au M, Simmons CF, Graham JM. Non-Cystic Fibrosis-Related Meconium Ileus: GUCY2C-Associated Disease Discovered through Rapid Neonatal Whole-Exome Sequencing. J Pediatr 2019; 211:207-210. [PMID: 31079856 DOI: 10.1016/j.jpeds.2019.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/18/2019] [Accepted: 04/10/2019] [Indexed: 12/12/2022]
Abstract
Meconium ileus is caused by cystic fibrosis; however, mutations in the GUCY2C gene also cause this disease. We report non-cystic fibrosis meconium ileus in an infant of non-Middle Eastern origin with compound heterozygous mutations in GUCY2C.
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Affiliation(s)
- Jeremy D Woods
- David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA
| | | | | | - Margaret Au
- Cedars-Sinai Medical Center, Los Angeles, CA
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15
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Yang HB, Han JW, Youn JK, Oh C, Kim HY, Jung SE. The Optimal Timing of Enterostomy Closure in Extremely Low Birth Weight Patients for Acute Abdomen. Sci Rep 2018; 8:15681. [PMID: 30356166 PMCID: PMC6200749 DOI: 10.1038/s41598-018-33351-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/24/2018] [Indexed: 11/25/2022] Open
Abstract
There are few reports on enterostomy closure (EC) timing for acute abdomen in extremely low birth weight (ELBW) patients. We retrospectively reviewed ELBW patients who underwent enterostomy formation (EF) and subsequent EC. We investigated baseline characteristics, surgical outcomes, and follow-up data of 55 patients and analyzed optimal timing by age at EC, enterostomy duration, and body weight (Bwt) at EC. The minimum p-value approach (MPA) using the Chi-squared test was used to determine each cut-off value. Mean gestational age was 25+3 weeks, while mean age and Bwt at EF were 10 days and 660 g. Enterostomy duration and Bwt at EC were 102 days and 2400 g. Fourteen surgical complications were related to EC. The MPA identified a cut-off of 2100 g (p = 0.039) at EC but no significant cut-off age or enterostomy duration. The 18 patients <2100 g had more enterostomy-related problems at EC than the >2100 g group (66.7% vs 10.8%, p < 0.001). No other characteristics were significantly different. Operation time, ventilator period, hospital stay, parenteral nutrition duration, and full feeding day were significantly longer in <2100 g patients. Follow-up Bwt did not differ (11.55 kg vs 13.95 kg, p = 0.324). Our findings suggest EC can be safely performed when Bwt is over 2100 g.
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Affiliation(s)
- Hee-Beom Yang
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Ji-Won Han
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Joong Kee Youn
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Chaeyoun Oh
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University, College of Medicine, Seoul, Korea.
| | - Sung Eun Jung
- Department of Pediatric Surgery, Seoul National University, College of Medicine, Seoul, Korea
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16
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Michikata K, Kodama Y, Kaneko M, Sameshima H, Ikenoue T, Machigashira S, Mukai M, Torikai M, Nakame K. Oral diatrizoate acid for meconium-related ileus in extremely preterm infants. Pediatr Int 2018; 60:714-718. [PMID: 29804321 DOI: 10.1111/ped.13606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 05/13/2018] [Accepted: 05/24/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intestinal disorders are common in very low-birthweight infants. The purpose of this study was to evaluate the impact of prophylactic oral Gastrografin® (diatrizoate acid) on meconium-related ileus (MRI) in extremely preterm infants. METHODS This was a retrospective case-control study of infants born extremely preterm at <28 weeks of gestation and treated with diatrizoate acid (prophylactic group) or not (control group) in the periods 2007-2014 and 2000-2009, respectively. In the 2007-2014 period, 120 infants received prophylactic diatrizoate acid solution. From the 165 infants in the control group, we selected 120 infants matched for gestational age. Cases of death before 72 h of life or congenital abnormalities were excluded. Intestinal disorders, time until full enteral feeding, duration of hospital stay, mortality rate, and neurodevelopmental outcome were compared. RESULTS MRI occurred in six infants in the control group and in none of the infants in the prophylactic group (P = 0.039). Median time until full enteral feeding was 25 versus 22 days (P < 0.01), hospital stay was 142 versus 126 days (P < 0.01), and mortality rate for infants aged 24-27 weeks was 8.2% versus 0% (P = 0.021), respectively. CONCLUSIONS Prophylactic oral diatrizoate acid reduced MRI in extremely preterm infants without side-effects and decreased the mortality rate of infants born at 24-27 weeks, and is thus beneficial in extremely preterm infants.
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Affiliation(s)
- Kaori Michikata
- Department of Obstetrics and Gynecology, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Yuki Kodama
- Department of Obstetrics and Gynecology, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Masatoki Kaneko
- Department of Obstetrics and Gynecology, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Hiroshi Sameshima
- Department of Obstetrics and Gynecology, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Tsuyomu Ikenoue
- Department of Obstetrics and Gynecology, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Seiro Machigashira
- Department of Pediatric Surgery, Kagoshima University, Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
| | - Motoi Mukai
- Department of Pediatric Surgery, Kagoshima University, Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
| | - Motofumi Torikai
- Department of Pediatric Surgery, Kagoshima University, Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
| | - Kazuhiko Nakame
- Department of Pediatric Surgery, Kagoshima University, Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
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17
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Shin J, Jeon GW. Successful Ultrasound-Guided Gastrografin Enema for Very Low Birth Weight Infants with Meconium-Related Ileus. NEONATAL MEDICINE 2018. [DOI: 10.5385/nm.2018.25.1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jaeho Shin
- Division of Pediatric Surgery, Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ga Won Jeon
- Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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18
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Ohashi K, Koshinaga T, Uehara S, Furuya T, Kaneda H, Kawashima H, Ikeda T. Sutureless enterostomy for extremely low birth weight infants. J Pediatr Surg 2017; 52:1873-1877. [PMID: 28866372 DOI: 10.1016/j.jpedsurg.2017.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/03/2017] [Accepted: 08/05/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE In recent years, improved survival rates of extremely low birth weight infants (ELBWIs) have led to an increasing number of enterostomy performed for those with meconium obstruction of prematurity (MOP)1,2, spontaneous intestinal perforation (SIP)3,4. To prevent serious stoma-related complications such as stoma side perforation, prolapse, fall and surgical site infection, we introduce our new "sutureless enterostomy" technique. METHODS We present the procedures in detail. We reviewed the medical records of twelve patients who underwent "sutureless enterostomy" in our neonatal intensive care unit from 2007 to 2013. Patient attributes, surgery-related items, stoma-related complications and outcomes were investigated. RESULTS Mean birth weight was 671±158g (mean±S.D.). Six cases of MOP, three cases of SIP and three cases of NEC were diagnosed. Mean operative time was 75±35min (mean±S.D.) None of them presented any of early stoma-related complications (necrosis, fall, and surgical site infection). However the parastomal hernia occurred in one patient as late complication. Three deaths occurred postoperatively as a result of exacerbations of their conditions. CONCLUSIONS Based on our preliminary observations, our new "sutureless enterostomy" was done safely and reduced the risk of stoma-related complications. It may be an ideal procedure for the ELBWI with MOP or SIP.
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Affiliation(s)
- Kensuke Ohashi
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan.
| | - Tsugumichi Koshinaga
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shuichiro Uehara
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Furuya
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hide Kaneda
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Kawashima
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Taro Ikeda
- Department of Surgery, Omiya Medical Center, Jichi Medical University, Saitama, Japan
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19
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Mochizuki K, Hayakawa M, Urushihara N, Miyake H, Yokoi A, Shiraishi J, Fujinaga H, Ohashi K, Esumi G, Ohfuji S, Amae S, Yanai T, Furukawa T, Tazuke Y, Minagawa K, Okuyama H. Timing and outcome of stoma closure in very low birth weight infants with surgical intestinal disorders. Surg Today 2017; 47:1001-1006. [PMID: 28247106 DOI: 10.1007/s00595-017-1498-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/25/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE Very low birth weight infants (VLBWIs) are at risk of surgical intestinal disorders including necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI). We conducted this study to verify whether the timing of stoma closure and that of enteral nutrition establishment after stoma closure in VLBWIs differ among the most common disorders. METHODS A retrospective multicenter study was conducted at 11 institutes. We reviewed the timing of stoma closure and enteral nutrition establishment in VLBWIs who underwent stoma creation for intestinal disorders. RESULTS We reviewed the medical records of 73 infants: 21 with NEC, 24 with FIP, and 25 with MRI. The postnatal age at stoma closure was 107 (28-359) days for NEC, 97 (25-302) days for FIP, and 101 (15-264) days for MRI (p = 0.793), and the postnatal age at establishment of enteral nutrition was 129 (42-381) days for NEC, 117 (41-325) days for FIP, and 128 (25-308) days for MRI (p = 0.855). The body weights at stoma closure were 1768 (620-3869) g for NEC, 1669 (1100-3040) g for FIP, and 1632 (940-3776) g (p = 0.614) for MRI. There were no significant differences among the three groups. CONCLUSIONS The present study revealed that the time and body weights at stoma closure and the postoperative restoration of bowel function in VLBWIs did not differ among the three diseases.
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Affiliation(s)
- Kyoko Mochizuki
- Department of Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, 232-0066, Japan.
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Akiko Yokoi
- Department of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Jun Shiraishi
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Hideshi Fujinaga
- Division of Neonatology, Center for Maternal-Fetal and Neonatal Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Ohashi
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Genshiro Esumi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoko Ohfuji
- Department of Public Health, Osaka University Faculty of Medicine, Osaka, Japan
| | - Shintaro Amae
- Department of Pediatric Surgery, Miyagi Children's Hospital, Sendai, Japan
| | - Toshihiro Yanai
- Department of Pediatric Surgery, Ibaraki Children's Hospital, Mito, Japan
| | - Taizo Furukawa
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuko Tazuke
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kyoko Minagawa
- Department of Pediatrics, Hyogo College of Medicine, Hyogo, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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20
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Abstract
OBJECTIVE To compare demographic data, prenatal and postnatal characteristics, laboratory data, and outcomes in a cohort of premature infants with spontaneous ileal perforation (SIP), surgical necrotizing enterocolitis (sNEC) and matched controls. METHODS A retrospective case-control study of infants with intestinal perforation with a birth weight (BW) less than 2,000 grams and gestational age (GA) less than 34 weeks and infants without perforation matched for BW (±150 grams) and GA (±1week). RESULTS 130 premature infants were included, 30 infants with SIP, 35 infants with sNEC and 65 control infants. The median age of onset was 5 days postnatal age in SIP versus 25 days in sNEC (p < 0.001) and the peak onset was at 26 weeks corrected GA for SIP and 30 weeks corrected GA for sNEC. Infants with perforation had significantly higher rates of mortality (p < 0.001) and common morbidities associated with prematurity. Administration of corticosteroids and indomethacin did not differ among groups. SIP was more common among infants born to young mothers (p = 0.04) and less common in infants receiving caffeine (p = 0.02). sNEC was less common among infants receiving early red cell transfusion (p = 0.01). Perforation and sNEC trended towards less common in infants receiving inhaled nitric oxide. CONCLUSION SIP and sNEC are distinct clinical entities. Potential protective effects of caffeine, inhaled nitric oxide, and early transfusion should be further studied.
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Affiliation(s)
- K Vongbhavit
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Nakhon-Nayok, Thailand
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| | - M A Underwood
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
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21
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Abstract
PURPOSE The purpose of this study is to identify the current clinical features of neonatal gastrointestinal perforation in Japan. METHODS A questionnaire about cases of neonatal gastrointestinal perforation treated in recent 5 years was sent to participating institutions of the Japanese Society of Pediatric Surgeons (JSPS). RESULTS Five hundred and thirty-six neonates with gastrointestinal perforation were treated. They consisted of 42 patients with gastric rupture/perforation (GR), 33 patients with intestinal atresia/stenosis (IA), 3 patients with malrotation (ML), 118 patients with necrotizing enterocolitis (NEC), 160 patients with focal intestinal perforation (FIP), 46 patients with meconium-related ileus (MRI), 77 patients with meconium peritonitis (MP), and 57 patients with other conditions. The total mortality rate was 20.5 %. The mortality rates of the patients with GR, IA, ML, NEC, FIP, MRI, and MP were 9.5, 9.1, 0, 33.1, 20.6, 28.2, and 9.1 %, respectively. In 263 cases involving extremely low-birth-weight neonates (ELBW), 108 died (mortality rate 41.1 %). The mortality rates for ELBW with GR, NEC, FIP, MRI, MP, and other conditions were 27.3 % (3/11), 58.5 % (48/82), 21.6 % (24/111), 70.6 % (24/34), 57.1 % (4/7), and 27.8 % (5/18), respectively. CONCLUSIONS The mortality rates for ELBW decreased from 62.8 % in the previous survey to 41.1 % by the time of this survey.
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22
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Yamoto M, Nakazawa Y, Fukumoto K, Miyake H, Nakajima H, Sekioka A, Nomura A, Ooyama K, Yamada Y, Nogami K, Van Y, Furuta C, Nakano R, Tanaka Y, Urushihara N. Risk factors and prevention for surgical intestinal disorders in extremely low birth weight infants. Pediatr Surg Int 2016; 32:887-93. [PMID: 27461434 DOI: 10.1007/s00383-016-3940-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 01/31/2023]
Abstract
PURPOSE Surgical intestinal disorders (SID), such as necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI), are serious morbidities in extremely low birth weight (ELBW, birth weight <1000 g) infants. From 2010, we performed enteral antifungal prophylaxis (EAP) in ELBWI to prevent for SID. The aim of this study was to identify disease-specific risk factors and to evaluate the efficacy of prevention for SID in ELBW infants. METHODS A retrospective chart review of all consecutive patients between January 2006 and March 2015, which included 323 ELBW infants who were admitted to Shizuoka Children's Hospital, was conducted. RESULTS The number of infants with NEC, FIP, and MRI was 9, 12, and 13, respectively; 28 in 323 ELBW infants died. The control group defined the cases were not SID. In-hospital mortality was higher in infants with NEC relative to those in the control group. On logistic regression analysis, low gestational age and cardiac malformations were associated with increased risk of NEC. IUGR were associated with increased risk of MRI. EAP decreased risk of NEC and FIP. Low gestational weight and NEC were associated with increased risk of death. CONCLUSION Survival to hospital discharge after operation for NEC in ELBW infants remains poor. EAP decreased risk of NEC and FIP in ELBW infants.
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Affiliation(s)
- Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan.
| | - Yusuke Nakazawa
- Department of Neonatalogy, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Hideaki Nakajima
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Akinori Sekioka
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Akiyoshi Nomura
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Kei Ooyama
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Yutaka Yamada
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Katsushi Nogami
- Department of Neonatalogy, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Yuko Van
- Department of Neonatalogy, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Chisako Furuta
- Department of Neonatalogy, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Reiji Nakano
- Department of Neonatalogy, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Yasuhiko Tanaka
- Department of Neonatalogy, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
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Okuyama H, Ohfuji S, Hayakawa M, Urushihara N, Yokoi A, Take H, Shiraishi J, Fujinaga H, Ohashi K, Minagawa K, Misaki M, Nose S, Taguchi T. Risk factors for surgical intestinal disorders in VLBW infants: Case-control study. Pediatr Int 2016; 58:34-9. [PMID: 26333186 DOI: 10.1111/ped.12815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 02/20/2015] [Accepted: 06/10/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Very low-birthweight (VLBW) infants (VLBWI) are at increased risk for surgical intestinal disorders including necrotizing enterocolitis (NEC), focal intestinal perforation (FIP) and meconium-related ileus (MRI). The aim of this study was to identify disease-specific risk factors for surgical intestinal disorders in VLBWI. METHODS A retrospective multicenter case-control study was conducted at 11 institutes. We reviewed VLBWI who underwent laparotomy for intestinal disorders including perforation and intractable bowel obstruction. The surgical disorders were classified into four categories (NEC, FIP, MRI, others) based on the macroscopic findings at operation. In order to identify risk factors, two matched controls for each subject were chosen based on gestational age and birthweight. OR and 95%CI were calculated using a conditional logistic regression model and a multivariate model. RESULTS A total of 150 cases (NEC, n = 44; FIP, n = 47; MRI, n = 42; others, n = 17) and 293 controls were identified. The cases and controls were similar in terms of gestational age and birthweight (cases/controls, 26.7 ± 2.5/26.5 ± 2.6 weeks; 790 ± 256/795 ± 257 g). On multivariate modeling, disease-specific risk factors were as follows: female (OR, 0.23; 95%CI: 0.06-0.89), respiratory distress syndrome (OR, 35.7; 95%CI: 2.48-514) and patent ductus arteriosus (OR, 10.9; 95%CI: 1.51-79.3) for NEC; outborn delivery (OR, 5.47; 95%CI: 1.48-20.2) for FIP; and twin pregnancy (OR, 4.25; 95%CI: 1.06-17.1), PROM (OR, 6.85; 95%CI: 1.33-35.4) and maternal steroid (OR, 0.23; 95%CI: 0.07-0.79) for MRI. CONCLUSIONS Different risk factors were identified for NEC, FIP and MRI, suggesting that each disease has a different etiology, and that different strategies are required to prevent these diseases.
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Affiliation(s)
- Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Satoko Ohfuji
- Department of Public Health, Faculty of Medicine, Osaka City University, Osaka, Japan
| | - Masahiro Hayakawa
- Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Akiko Yokoi
- Department of Pediatric Surgery, Hyogo Children's Hospital, Kobe, Japan
| | - Hiroshi Take
- Department of Pediatric Surgery, Kanagawa Children's Hospital, Yokohama, Japan
| | - Jun Shiraishi
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | - Hideshi Fujinaga
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Ohashi
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Kyoko Minagawa
- Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Maiko Misaki
- Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Satoko Nose
- Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan
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Woo HK, Kim EK, Jung YH, Shin SH, Kim HS, Choi JH, Kim HY. Reduced early dried blood spot citrulline levels in preterm infants with meconium obstruction of prematurity. Early Hum Dev 2015; 91:777-81. [PMID: 26427641 DOI: 10.1016/j.earlhumdev.2015.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/25/2015] [Accepted: 09/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Citrulline is a non-protein amino acid synthesized in the enterocytes of the small bowel. Recent studies have reported that plasma citrulline levels correlate with functional enterocyte mass. AIMS This study aimed to determine the normal dried blood spot (DBS) citrulline levels and to determine the existence of a correlation between citrulline levels and meconium obstruction of prematurity (MOP). STUDY DESIGN AND SUBJECTS A retrospective cohort study was performed involving 285 infants born at less than 32weeks gestation who were admitted to the neonatal intensive care unit between Oct 2009 and Aug 2014. OUTCOME MEASURES We analyzed the DBS citrulline levels, which are routinely measured via newborn screening at 7days following birth, using liquid chromatography-MS/MS. We investigated the relationship between DBS citrulline levels and clinical parameters such as gestational age (GA), body measurements at birth, gender, or the presence or absence of either necrotizing enterocolitis or MOP. RESULTS A total of 229 infants with a median GA of 29.6weeks and a median birth weight of 1160g were included. DBS citrulline levels were not associated with GA, body measurements at birth or gender. DBS citrulline levels were significantly decreased when patients presented with MOP (p=0.037). CONCLUSIONS Early DBS citrulline levels were not associated with either GA or body measurements at birth but were reduced among preterm infants with MOP compared with the control infants. These results may be indicative of abnormal fetal intestinal development and reduced functional enterocyte mass among preterm infants with MOP.
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Affiliation(s)
- Hae Kyung Woo
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Kim HY, Kim SH, Cho YH, Byun SY, Han YM, Kim AY. Meconium-related ileus in very low birth weight and extremely low birth weight infants: immediate and one-year postoperative outcomes. Ann Surg Treat Res 2015; 89:151-7. [PMID: 26366385 PMCID: PMC4559618 DOI: 10.4174/astr.2015.89.3.151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 03/20/2015] [Accepted: 04/24/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE One of the major causes of bowel obstruction in extremely premature infants is a meconium obstruction. However, there are many challenges not only in the recognition and diagnosis, but also in the management of meconium obstruction. This study aimed to find perioperative clinical features and determine the postoperative course of meconium-related ileus in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. METHODS We retrospectively reviewed the clinical data of premature infants (n = 11, VLBW infnats; n = 16, ELBW infants) with a meconium-related ileus who underwent operation for intractable ileus between January 2009 and May 2013. RESULTS The average duration of conservative management was longer and postnatal age was older in ELBW infants than VLBW infants: 19.9 days vs. 11.5 days and 34.9 days vs. 19.2 days. The immediate postoperative course (day that beginning feeding and full feeding) was not significantly different based on birth weight, but the ELBW infants had slightly higher mortality. At 12 months of corrected age after operation, both average body weight and average height was below 10th percentile for growth in most infants (61.1%). CONCLUSION There was a slightly high mortality in the ELBW infants, but two groups did not experience significant differences in the immediate postoperative course of meconium-related ileus. Nevertheless, considering their growth patterns, it is necessary to do a close follow-up and more aggressive nutritional management to achieve optimal growth and development in both patient groups.
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Affiliation(s)
- Hae-Young Kim
- Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea. ; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soo-Hong Kim
- Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Yong-Hoon Cho
- Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea. ; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Shin-Yun Byun
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Young-Mi Han
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| | - Ah-Young Kim
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
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Hirano K, Kubota A, Nakayama M, Kawahara H, Yoneda A, Tazuke Y, Tani G, Ishii T, Goda T, Umeda S, Hirno S, Shiraishi J, Kitajima H. Parenteral nutrition-associated liver disease in extremely low-birthweight infants with intestinal disease. Pediatr Int 2015; 57:677-81. [PMID: 25728615 DOI: 10.1111/ped.12609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 01/03/2015] [Accepted: 02/04/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND The aim of this study was to investigate factors associated with the development of parenteral nutrition-associated liver disease (PNALD) and to examine the clinicopathological relationship of PNALD in extremely low-birthweight infants (ELBWI). METHODS The subjects were 13 ELBWI who had received PN because of intestinal perforation or functional ileus between 2000 and 2013. We measured the serum levels of biochemical parameters, including aspartate aminotransferase, alanine aminotransferase, and direct bilirubin. Liver histopathology was examined in relation to outcome. The subjects were categorized into two groups on liver histopathology: F(+), development of hepatic fibrosis and necrosis with/without cholestasis; and F(-), no hepatic fibrosis. RESULTS Of 13 ELBWI, five died of hepatic failure, five died of sepsis, and the other three were alive at the time of the study. Of the five infants who died of hepatic failure, two developed fulminant hepatitis without cholestasis, and the other three developed chronic cholestasis and finally hepatic failure. Postmortem histopathology in F(+) indicated not only massive hepatic necrosis, but also massive hepatic fibrosis. These histopathological findings explained the clinical presentation of portal hypertension. There were significant differences in the fasting period after intestinal disease onset between the two groups. CONCLUSION The prolonged fasting with PN is responsible for severe hepatocellular necrosis with fibrosis and consequent lethal portal hypertension.
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Affiliation(s)
- Katsuhisa Hirano
- Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Akio Kubota
- Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Masahiro Nakayama
- Clinical Laboratory Medicine and Anatomic Pathology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Hisayoshi Kawahara
- Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Akihiro Yoneda
- Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Yuko Tazuke
- Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Gakuto Tani
- Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Tomohiro Ishii
- Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Taro Goda
- Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Satoshi Umeda
- Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Shinya Hirno
- Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Jun Shiraishi
- Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Hirnoyuki Kitajima
- Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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Hayakawa M, Taguchi T, Urushihara N, Yokoi A, Take H, Shiraishi J, Fujinaga H, Ohashi K, Oshiro M, Kato Y, Ohfuji S, Okuyama H. Outcome in VLBW infants with surgical intestinal disorder at 18 months of corrected age. Pediatr Int 2015; 57:633-8. [PMID: 25639880 DOI: 10.1111/ped.12594] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 12/27/2014] [Accepted: 01/19/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical intestinal disorders, such as necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI), are serious morbidities in very low-birthweight infants (VLBWI). The aim of this study was to compare the composite outcomes of death or neurodevelopmental impairment (NDI) in VLBWI with surgical intestinal disorders and assess independent risk factors for death and NDI at 18 months of corrected age. METHODS A retrospective matched-cohort study was conducted at 11 institutes. We included VLBWI who had undergone laparotomy for NEC, FIP, and MRI. Two control subjects were chosen for every surgical patient and matched for gestational age and birthweight to form the comparison group. Death and neurodevelopmental outcome at 18 months of corrected age were evaluated. RESULTS The number of infants in the NEC, FIP, MRI, and control groups was 44, 47, 42, and 261, respectively. In-hospital mortality was higher in infants with NEC and MRI relative to those in the control group (P < 0.001). The incidence rate for NDI at 18 months of corrected age was higher in infants with MRI relative to those in the control group (P = 0.021). On logistic regression analysis, low gestational age, male sex, small for gestational age, intraventricular hemorrhage, and MRI were associated with increased risk of death or NDI at 18 months of corrected age. CONCLUSIONS NEC and MRI were associated with in-hospital mortality, and MRI was associated with NDI or death at 18 months of corrected age.
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Affiliation(s)
- Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Akiko Yokoi
- Department of Pediatric Surgery, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Hiroshi Take
- Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Jun Shiraishi
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Tokyo, Japan
| | - Hideshi Fujinaga
- Division of Neonatology, Center for Maternal-Fetal and Neonatal Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Ohashi
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Oshiro
- Department of Neonatology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Yuichi Kato
- Department of Pediatrics, Anjo Kosei Hospital, Anjo, Japan
| | - Satoko Ohfuji
- Department of Public Health, Osaka City University Faculty of Medicine, Osaka, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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Cho HH, Cheon JE, Choi YH, Lee SM, Kim WS, Kim IO, Shin SM, Kim EK, Kim HS, Choi JH, You SK. Ultrasound-guided contrast enema for meconium obstruction in very low birth weight infants: Factors that affect treatment success. Eur J Radiol 2015; 84:2024-31. [PMID: 26159485 DOI: 10.1016/j.ejrad.2015.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/27/2015] [Accepted: 06/04/2015] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study aimed to assess the therapeutic results of ultrasound (US)-guided water-soluble contrast enema in very low birth weight (VLBW) preterm infants (<1,500 g) with meconium obstruction and to study factors that affect therapeutic results. METHODS This study included a total of 33 consecutive VLBW infants with clinically diagnosed meconium obstruction underwent US-guided water-soluble contrast enema, from April 2007 to March 2014. Patients were classified into two groups based on to procedure outcome: the success group (evacuation of the meconium plug resolution followed by improved bowel distention within 2 days of the procedure, without additional interventions), and the failure group (the contrast enema failed to relieve the obstruction, or other procedure-related complications occurred). Patient- and mother-related clinical factors and procedure-related factors were compared between both groups. RESULTS Overall success rate was 54.5%, with 18 successful (M:F=10:8), and 15 failure (M:F=7:8) cases. When compared with the failure group, the success group patients showed statistically significant older gestational age (29(+1) vs. 27 weeks; p=0.028), larger birth weight (1023.1g vs. 790.3g; p=0.048), and higher body weight on the day of the procedure (1036.2g vs. 801.6g, p=0.049). However, no statistically significant differences were seen between other patient and maternal factors. Among the procedure-related factors, retrial of contrast injection during the procedure was associated with significantly higher success than the single trial (p=0.027). The presence of refluxed contrast into the distal ileum was the statistically significant predictor for success of the procedure (p=0.038). There were three cases of bowel perforation (9.1% per person). CONCLUSION US-guided water-soluble contrast enema in VLBW infants with meconium obstruction showed a 54.5% success rate and a 9.1% perforation rate per person. Among the procedure-related factors, retrial of contrast injection during the procedure and the presence of refluxed contrast into the distal ileum were related to the success of the procedure.
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Affiliation(s)
- Hyun-Hae Cho
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea.
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, South Korea
| | - So Mi Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea
| | - In-One Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea
| | - Su-Mi Shin
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Hwan Choi
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sun Kyoung You
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea
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Kwon HS, Jung JM, Lim YJ, Nam SH, Lim G, Chung ML. Impact of Meconium Obstruction-Related Risk Factors on Surgical Intervention in Very Low Birth Weight Infants. NEONATAL MEDICINE 2015. [DOI: 10.5385/nm.2015.22.2.84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Hyun Sop Kwon
- Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji Mi Jung
- Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yun-Jung Lim
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - So-Hyun Nam
- Department of Surgery, Dong A University Hospital, Busan, Korea
| | - Gina Lim
- Department of Pediatrics, Ulsan University Hospital, Ulsan, Korea
| | - Mi Lim Chung
- Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Hatanaka A, Nakahara S, Takeyama E, Iwanaka T, Ishida K. Management of extremely low birth weight neonates with bowel obstruction within 2 weeks after birth. Surg Today 2014; 44:2269-74. [DOI: 10.1007/s00595-013-0824-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 12/10/2013] [Indexed: 11/30/2022]
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Kubota A, Mochizuki N, Shiraishi J, Nakayama M, Kawahara H, Yoneda A, Tazuke Y, Goda T, Nakahata K, Sano H, Hirano S, Kitajima H. Parenteral-nutrition-associated liver disease after intestinal perforation in extremely low-birthweight infants: consequent lethal portal hypertension. Pediatr Int 2013; 55:39-43. [PMID: 23240986 DOI: 10.1111/ped.12026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 09/12/2012] [Accepted: 09/21/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Parenteral nutrition (PN)-associated liver dysfunction (PNALD) in term infants usually manifests as intrahepatic cholestasis, which recovers with enteral nutrition (EN) in most cases; however, as the number of extremely low-birthweight infants (ELBWI) has been increasing, and consequently intestinal diseases associated with ELBWI have been increasing, more intractable PNALD has been encountered after surgical treatment in ELBWI, which does not resolve or rather worsens with EN. METHODS Three cases of ELBWI with intestinal perforation, which developed PNALD and eventually died of hepatic failure with intractable portal hypertension, were reviewed. Their gestational age and birthweight ranged from 23 to 26 weeks, and from 434 to 968 g, respectively. The intestinal diseases included necrotizing enteritis in two and meconium-related ileus with focal intestinal perforation in one. RESULTS The duration of total PN without EN in the three cases was 17, 24 and 24 days, respectively. The interval between the introduction of PN and the onset of PNALD was 14, 4 and 18 days, respectively. A marked elevation of serum endotoxin level was detected in both cases of necrotizing enteritis. Histopathological study of the liver revealed marked cholestasis, significant hepatic necrosis with fibrosis, and proliferation of ductules in all these cases, which was responsible for portal hypertension. CONCLUSIONS PN after gastrointestinal disorders in ELBWI may cause refractory PNALD, which does not resolve, or rather worsens with the resumption of EN. Portal hypertension secondary to hepatic necrosis may be responsible for the exacerbation with the resumption of EN.
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Affiliation(s)
- Akio Kubota
- Department of Pediatric Surgery, Osaka, Japan.
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Yu HY, Shin JE, Eun HS, Lee SM, Park MS, Lee MJ, Kim MJ, Namgung R, Lee C, Park KI. Meconium-related Ileus in Extremely Low-birth Weight Newborn Infants Meconium-related Ileus in ELBWI. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.1.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ha Yang Yu
- Division of Neonatalogy, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Eun Shin
- Division of Neonatalogy, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Seon Eun
- Division of Neonatalogy, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Division of Neonatalogy, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Park
- Division of Neonatalogy, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Jung Lee
- Department of Radiology, Yonsei university College of Medicine, Seoul, Korea
| | - Myung Jun Kim
- Department of Radiology, Yonsei university College of Medicine, Seoul, Korea
| | - Ran Namgung
- Division of Neonatalogy, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Lee
- Division of Neonatalogy, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kook In Park
- Division of Neonatalogy, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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