Surgical intervention in necrotizing enterocolitis in neonates with symptomatic congenital heart disease

The commonly accepted indication for surgical intervention in necrotizing enterocolitis (NEC) is perforation of the bowel. In this study, the indication and role of surgery was assessed in neonates born with symptomatic congenital heart disease (CHD). Records of neonates admitted to a single institu...

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Veröffentlicht in:Pediatric surgery international 1999-09, Vol.15 (7), p.492-495
Hauptverfasser: CHENG, W, LEUNG, M. P, TAM, P. K. H
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description The commonly accepted indication for surgical intervention in necrotizing enterocolitis (NEC) is perforation of the bowel. In this study, the indication and role of surgery was assessed in neonates born with symptomatic congenital heart disease (CHD). Records of neonates admitted to a single institution in Hong Kong between January 1981 and December 1997 with symptomatic CHD who subsequently developed NEC were reviewed. The patients were categorized into cyanotic and acyanotic groups. Of 850 neonates with CHD admitted during the period, 30 developed NEC (3.5%); 17 had cyanotic and 13 had acyanotic heart disease. The average Apgar scores at 1 and 5 min were 7.5 and 8.6, respectively. The mean gestational age was 37.7 weeks and the mean birth weight was 2.5 kg. The mean age at which NEC developed was 16 days. The overall mortality in the proven cases of NEC was 57%. After excluding the suspected NEC cases (stage I), it was found that surgery in the proven NEC cases without perforation, i.e., stages II and IIIA, resulted in higher survival than in those managed medically (75% vs 44%). The cyanotic patients had higher mortality than the acyanotic group (71% vs 39%). Neonates with CHD who develop NEC belong to a unique group of mature babies with reasonable birth weights and Apgar scores, unlike the common NEC patient population. The mortality of these patients is extremely high, and a modified management approach is required. Surgical intervention may be indicated at a much earlier stage of proven NEC before gut perforation occurs.
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P</creatorcontrib><creatorcontrib>TAM, P. K. H</creatorcontrib><title>Surgical intervention in necrotizing enterocolitis in neonates with symptomatic congenital heart disease</title><title>Pediatric surgery international</title><addtitle>Pediatr Surg Int</addtitle><description>The commonly accepted indication for surgical intervention in necrotizing enterocolitis (NEC) is perforation of the bowel. In this study, the indication and role of surgery was assessed in neonates born with symptomatic congenital heart disease (CHD). Records of neonates admitted to a single institution in Hong Kong between January 1981 and December 1997 with symptomatic CHD who subsequently developed NEC were reviewed. The patients were categorized into cyanotic and acyanotic groups. Of 850 neonates with CHD admitted during the period, 30 developed NEC (3.5%); 17 had cyanotic and 13 had acyanotic heart disease. The average Apgar scores at 1 and 5 min were 7.5 and 8.6, respectively. 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The mortality of these patients is extremely high, and a modified management approach is required. Surgical intervention may be indicated at a much earlier stage of proven NEC before gut perforation occurs.</abstract><cop>Heidelberg</cop><cop>Berlin</cop><pub>Springer</pub><pmid>10525907</pmid><doi>10.1007/s003830050647</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record>
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subjects Biological and medical sciences
Enterocolitis, Necrotizing - complications
Enterocolitis, Necrotizing - mortality
Enterocolitis, Necrotizing - surgery
Female
Gastroenterology. Liver. Pancreas. Abdomen
Heart Defects, Congenital - complications
Humans
Infant, Newborn
Male
Medical sciences
Other diseases. Semiology
Retrospective Studies
Stomach, duodenum, intestine, rectum, anus
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Survival Analysis
title Surgical intervention in necrotizing enterocolitis in neonates with symptomatic congenital heart disease
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