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Hurley A, Wiltshire J, Miall L. Complications of nasojejunal tube insertion in the neonate. Arch Dis Child Educ Pract Ed 2023; 108:146-149. [PMID: 35078824 DOI: 10.1136/archdischild-2021-322669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/18/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Aoife Hurley
- Neonatal Medicine, Leeds General Infirmary, Leeds, UK
| | - Joseph Wiltshire
- Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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2
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Transillumination in neonatal gastric perforation. J Paediatr Child Health 2021; 57:760. [PMID: 33963647 DOI: 10.1111/jpc.2_15242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 11/27/2022]
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Harahap A, Harianto A, Etika R, Utomo MT, Angelika D, Handayani KD, Arif Sampurna MT. Spontaneous Ileum Perforation in a premature twin with Coronavirus-19 positive mother. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021; 67:101807. [PMID: 33564621 PMCID: PMC7860962 DOI: 10.1016/j.epsc.2021.101807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 10/31/2022] Open
Abstract
Spontaneous intestinal perforation (SIP) of the newborn is a single intestinal perforation commonly found in the terminal ileum without distinct causes. These cases often associated with prematurity. The new COVID-19 in pregnancy increased the risk of premature rupture of membranes, preterm delivery, intrauterine fetal death (IUFD), and low birth weight (LBW). Here we report a premature twin with SIP that was born from Coronavirus-19 positive mother.
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Affiliation(s)
- Aminuddin Harahap
- Department of Pediatrics, Faculty of Medicine, Dr. Soetomo General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Agus Harianto
- Department of Pediatrics, Faculty of Medicine, Dr. Soetomo General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Risa Etika
- Department of Pediatrics, Faculty of Medicine, Dr. Soetomo General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Martono Tri Utomo
- Department of Pediatrics, Faculty of Medicine, Dr. Soetomo General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Dina Angelika
- Department of Pediatrics, Faculty of Medicine, Dr. Soetomo General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Kartika Darma Handayani
- Department of Pediatrics, Faculty of Medicine, Dr. Soetomo General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Mahendra Tri Arif Sampurna
- Department of Pediatrics, Faculty of Medicine, Dr. Soetomo General Hospital, Universitas Airlangga, Surabaya, Indonesia
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Lodhia J, Msuya D, Philemon R, Sadiq A, Mremi A. Gastric perforation resulting into pneumoperitoneum in a neonate: a case report. J Surg Case Rep 2020; 2020:rjaa298. [PMID: 32874545 PMCID: PMC7449603 DOI: 10.1093/jscr/rjaa298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/13/2020] [Indexed: 11/15/2022] Open
Abstract
Gastric perforation in a neonate is a rare surgical emergency in routine practice. The causes and predisposing factors for gastric perforation in a neonate vary from traumatic to benign conditions like inflammatory processes. Early detection, intensive care, stabilization and prompt surgery yield positive outcome. Early diagnosis is important for better prognosis. Simple investigation such as plain abdominal X-ray can adequately lead to the diagnosis by showing pneumoperinoneum. We present a 3-day-old neonate; born at term who presented with abdominal distension and vomiting. Plain abdominal X-ray revealed pneumoperitoneum. Emergency laparotomy was performed where a gastric perforation was found measuring 0.5 by 0.5 cm located on the anterior aspect of the stomach body near the pylorus. The baby underwent successful surgical intervention and recovered well.
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Affiliation(s)
- Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - David Msuya
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Rune Philemon
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Adnan Sadiq
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Alex Mremi
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Air Leak Syndrome: Pneumoperitoneum in a Ventilated Neonate. Case Rep Pediatr 2020; 2019:4238601. [PMID: 31956461 PMCID: PMC6949679 DOI: 10.1155/2019/4238601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/02/2019] [Indexed: 11/18/2022] Open
Abstract
Air leak syndrome has several manifestations and is common in neonates with meconium aspiration syndrome (MAS) due to air trapping. While pneumoperitoneum is classically a result of intestinal perforation, intra-abdominal free air may be a less common presentation of air leak syndrome. In the ventilated neonate, there is insufficient clinical evidence outlining management of pneumoperitoneum in this situation. We report a case of a term neonate with MAS and air leak syndrome who developed benign pneumoperitoneum (BPPT).
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Kahn DJ, Gregorisch S, Whitehouse JS, Fisher PD. Delayed diagnosis of spontaneous intestinal perforation among very low birth weight neonates: A single center experience. J Perinatol 2019; 39:1509-1520. [PMID: 31462722 DOI: 10.1038/s41372-019-0480-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/27/2019] [Accepted: 07/20/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess incidence and effect of delayed diagnosis of spontaneous intestinal perforation (SIP). STUDY DESIGN Retrospective case series review of 58 VLBW neonates with SIP at our institution. RESULT SIP was diagnosed in 6.1%, 10%, and 15.1% of VLBW, ELBW, and ≤750 g neonates, respectively. Abdominal distension (58.6%) and abdominal discoloration (53.4%) were the most common presenting signs/symptoms. Smaller (≤750 g) neonates were more likely to present with hypotension and higher FiO2, and larger (751-1500 g) neonates with increased abdominal girth and abdominal distension. All but one neonate had radiographic pneumoperitoneum, and 25.9% had pneumoperitoneum on an X-ray prior to the X-ray at SIP diagnosis. An education module reduced delay in SIP diagnosis. CONCLUSION SIP presentation varies by birth weight and gestational age. Since SIP diagnosis is often first suggested on X-ray, all X-rays of VLBW neonates in the first 2 weeks of life should be scrutinized for pneumoperitoneum.
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Affiliation(s)
- Doron J Kahn
- Division of Neonatology, Joe DiMaggio Children's Hospital, Hollywood, FL, USA. .,Envision Healthcare, Plantation, FL, USA.
| | - Sandra Gregorisch
- Division of Neonatology, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Jill S Whitehouse
- Division of Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Paul D Fisher
- Envision Healthcare, Plantation, FL, USA.,Division of Pediatric Radiology, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
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Markiet K, Szymanska-Dubowik A, Janczewska I, Domazalska-Popadiuk I, Zawadzka-Kepczynska A, Bianek-Bodzak A. Agreement and reproducibility of radiological signs in NEC using The Duke Abdominal Assessment Scale (DAAS). Pediatr Surg Int 2017; 33:335-340. [PMID: 27844167 PMCID: PMC5310549 DOI: 10.1007/s00383-016-4022-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Necrotizing enterocolitis (NEC) is associated with high morbidity and mortality. Abdominal radiography is currently an imaging modality of choice in NEC. Recently, a numeric scale of radiological signs in NEC-The Duke Abdominal Assessment (DAAS) was introduced. The aim of this study was to measure the intra- and inter-observer agreement on the radiological signs of NEC according to DAAS to access the feasibility of this scale. MATERIALS AND METHODS We have retrospectively analyzed 87 radiographs performed in a group of 43 high-risk neonates with suspected NEC. Radiographs were assessed by 6 independent observers: two pediatric radiologists, two radiology residents, and two neonatologists. Data were analyzed using κ statistics as a measure of intra- and inter-observer agreement. RESULTS Fair-to-good intra-observer agreement was noted for all but one of observers. However, with the wide range in κ values, we found only fair inter-observer agreement detecting signs of NEC according to DAAS. There was a higher intra-group agreement in radiology practitioners, with the highest among experienced pediatric radiologists. CONCLUSION However, with high observer variability in interpretation of all radiologic signs, we did not confirm that Duke Abdominal Assessment Scale could reliable facilitate reporting of abdominal radiographic findings in neonates with suspected NEC.
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Affiliation(s)
- Karolina Markiet
- II Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | | | - Iwona Janczewska
- Department of Neonatology, Medical University of Gdansk, Gdansk, Poland
| | | | - Anna Zawadzka-Kepczynska
- Department of Radiology, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
| | - Agnieszka Bianek-Bodzak
- Department of Radiology, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
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Prgomet S, Lukšić B, Pogorelić Z, Jurić I, Čapkun V, Arapović A, Boban N. Perinatal risk factors in newborns with gastrointestinal perforation. World J Gastrointest Surg 2017; 9:46-52. [PMID: 28289509 PMCID: PMC5329703 DOI: 10.4240/wjgs.v9.i2.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/10/2016] [Accepted: 12/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate correlation of perinatal risk factors in newborns with gastrointestinal perforation (GIP).
METHODS Single-center retrospective cohort study was conducted between January 1990 and December 2012. Medical records on all newborns with GIP were reviewed (n = 35). Surgical records and histopathologic examination of all perforated intestine samples were also reviewed.
RESULTS The most common cause of GIP was necrotizing enterocolitis (51.4%). The most common site of perforation was large intestine. Mortality rate was 31%. Infants with GIP more frequently had very low birth weight (< 1500 g), especially birth weight below 10th percentile according to gestational age. Ponderal index was not differing between infants with GIP and control subjects. In infants with GIP anemia was more frequently found than in control group.
CONCLUSION GIP in newborns is mostly disease of infants with birth weight below 10th percentile according to gestational age. GIP occurs more often in infants with anemia.
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Prasad GR, Aziz A. Abdominal Plain Radiograph in Neonatal Intestinal Obstruction. J Neonatal Surg 2017; 6:6. [PMID: 28083492 PMCID: PMC5224763 DOI: 10.21699/jns.v6i1.483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 11/30/2016] [Indexed: 11/12/2022] Open
Abstract
A comprehensive all-inclusive resource on plain radiograph in neonatal intestinal obstruction is presented. This is an attempt to develop a protocol and to regain expertise in evaluating a plain radiograph that most often yields more than enough clues to diagnose and to decide a plan of action.
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Affiliation(s)
| | - Amtul Aziz
- Deccan College of Medical Sciences and Princess Esra Hospital, Hyderabad
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Chioukh FZ, Ben Ameur K, Laamiri R, Ben Hmida H, Nouri A, Monastiri K. Spontaneous Intestinal Perforation in a Very Low Birth Weight Infant: Successful Management by Peritoneal Needle Suction. J Neonatal Surg 2016; 5:39. [PMID: 27433457 PMCID: PMC4942439 DOI: 10.21699/jns.v5i3.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/11/2016] [Indexed: 12/01/2022] Open
Affiliation(s)
- Fatma-Zohra Chioukh
- Department of Intensive Care and Neonatal Medicine, Teaching Hospital of Monastir, University of Monastir - Tunisia
| | - Karim Ben Ameur
- Department of Intensive Care and Neonatal Medicine, Teaching Hospital of Monastir, University of Monastir - Tunisia
| | - Rachida Laamiri
- Department of Paediatric Surgery, Teaching Hospital of Monastir, University of Monastir - Tunisia
| | - Hayet Ben Hmida
- Department of Intensive Care and Neonatal Medicine, Teaching Hospital of Monastir, University of Monastir - Tunisia
| | - Abellatif Nouri
- Department of Paediatric Surgery, Teaching Hospital of Monastir, University of Monastir - Tunisia
| | - Kamel Monastiri
- Department of Intensive Care and Neonatal Medicine, Teaching Hospital of Monastir, University of Monastir - Tunisia
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El-Kady S, Petel D, Baird R. Inter-rater agreement in the evaluation of abdominal radiographs for necrotizing enterocolitis. J Pediatr Surg 2014; 49:733-5. [PMID: 24851758 DOI: 10.1016/j.jpedsurg.2014.02.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 02/13/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE Abdominal radiographs are frequently employed in the surveillance of patients with necrotizing enterocolitis (NEC), with typical findings well described. Clinicians interpret and act upon these films at different intervals, however, and inter-rater agreement has not been evaluated to date. METHODS Thirty abdominal radiographs of premature infants were distributed to attending radiologists (4), pediatric surgeons (4), and trainees (4), who evaluated for findings of NEC from a list of eight potential choices (1=normal, 8=perforation). Fleiss's Kappa (FK) was used to evaluate concordance between multiple raters with 0-0.2=slight association and 0.8-1=almost perfect agreement. RESULTS Practicing surgeons had an FK of 0.77 overall (95% CI: 0.67-0.87), but demonstrated poor agreement when evaluating decubitus films (FK: 0.39, 95% CI:0.12-0.65). Radiologists had excellent inter-rater agreement (FK: 0.81, 95% CI: 0.74-0.88), but had only modest agreement with surgeons (FK: 0.59, 95% CI: 0.56-0.63) and poor agreement for decubitus films (FK: 0.15, 95% CI: 0.47-0.26). Surgical and radiology trainees had fair agreement with their respective attendings (0.60, 95% CI: 0.55-0.65 and 0.64, 95% CI: 0.60-0.69, respectively). CONCLUSIONS While inter-rater agreement was good-excellent among attending staff, it was only moderate between radiologists and surgeons and between trainees and their attendings. This highlights the importance of inter-disciplinary and hierarchical communication to optimize clinical decision-making. Decubitus films may be of limited value in evaluating patients with NEC.
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Affiliation(s)
- Sherif El-Kady
- Department of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University, Montreal Quebec, Canada; McGill University, Montreal Quebec, Canada; Department of Radiology, The Montreal Children's Hospital, McGill University, Montreal Quebec, Canada
| | - Dara Petel
- Department of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University, Montreal Quebec, Canada; McGill University, Montreal Quebec, Canada; Department of Radiology, The Montreal Children's Hospital, McGill University, Montreal Quebec, Canada
| | - Robert Baird
- Department of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University, Montreal Quebec, Canada; McGill University, Montreal Quebec, Canada; Department of Radiology, The Montreal Children's Hospital, McGill University, Montreal Quebec, Canada.
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Gastrointestinal perforation in neonates: aetiology and risk factors. J Neonatal Surg 2013; 2:30. [PMID: 26023450 PMCID: PMC4422271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 06/29/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Gastrointestinal perforation (GIP) in neonates presents important challenges and mortality can be high. This is a report of recent experience with GIP in neonates in a developing country. PATIENTS AND METHODS A retrospective review of 16 neonates treated for GIP in a 3 year period. RESULTS There were 9 males and 7 females, aged 0-28 days (median age =7days). Their weights at presentation ranged from 0.9 - 4.7kg (median =2.6). Five infants were premature. Twelve infants presented more than 72 hours after onset of symptoms. Plain abdominal radiographs showed peumoperitoneum in 9 infants. The cause of perforation was necrotising enterocolitis 6, intestinal obstruction 6, iatrogenic 3 and spontaneous 1. The site of perforation was ileum in 12 infants, stomach in 4 and colon in 4; 4 patients had involvement of more than one site. All the neonates underwent exploratory laparotomy with primary closure ( n=5) , resection and anastomosis( n=6), colostomy (n=3), Ileostomy ( n=2), partial gastrectomy (n=2) ,or gastrojejunostomy ( n=1). Two neonates had multiple procedures. Two very sick preterm babies had an initial peritoneal lavage. Surgical site infection is the commonest postoperative complication occurring in 9 infants. Anaesthesia sepsis and malnutrition is responsible for the seven deaths recorded. CONCLUSIONS Neonatal GIP has multiple aetiologies; NEC is the most common cause. Major mortality risk factors include NEC, multiple perforations, delayed presentation and prematurity.
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Neonatal gastric perforation with tension pneumo-peritoneum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Oh BY, Choi KJ. Prognostic Factors of Surgically Treated Pneumoperitoneum in Neonates. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.77.2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bo-young Oh
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kum-ja Choi
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
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Abstract
So much is unknown about SIP-its etiology, pathophysiology, best treatment modality, and outcome. Yet the incidence of SIP is increasing as more VLBW infants are surviving and since SIP has been identified as a separate disease from NEC. Because many cases present with an insidious onset, it is imperative that practitioners review all x-rays with SIP in mind. Although SIP is a relatively rare occurrence in the NICU, its potential to increase morbidity and mortality in premature infants warrants further research to improve outcomes.
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