Emergency laparotomy in infants born at <26 weeks gestation: a neonatal network based cohort study of frequency, surgical pathology and outcomes
Emergency laparotomy in infants born at <26 weeks gestation: a neonatal network based cohort study of frequency, surgical pathology and outcomes
Objective Identify the proportion of infants born at <26 completed weeks’ gestation who require emergency laparotomy, and review the surgical pathology, incidence of subsequent surgical procedures and outcome.
Design Retrospective cohort review.
Setting Tertiary neonatal surgical unit.
Patients All infants born at <26 weeks’ gestation in a neonatal network over an 8-year period.
Results Of 381 infants, laparotomy was indicated in 61 (16%) and performed in 57. Surgical pathology encountered included spontaneous intestinal perforation (SIP) (28), necrotising enterocolitis (NEC) (14), volvulus without malrotation (1), strangulated inguinal hernia (1), milk curd obstruction (4), NEC stricture (1) and meconium obstruction of prematurity (2). No intestinal pathology was found in six. Four infants with indications for laparotomy and severe comorbidity had intensive care withdrawn without surgery. The most frequent procedure performed was resection with primary anastomosis. Nine infants (16%) required more than one laparotomy. Of the 16 infants who had stoma formation, eight had closure before discharge. Fifteen infants required surgical patent ductus arteriosus ligation following laparotomy, and 17 had laser therapy for retinopathy of prematurity. Overall 42 infants with indication for laparotomy (69%) survived to discharge.
Conclusions Nearly one in six infants born at <26 weeks required emergency laparotomy. The most frequent pathology encountered was SIP (49%), followed by NEC (25%). Over one-quarter required subsequent gastrointestinal surgery, with many also requiring cardiothoracic and ophthalmic procedures. These data are important for those caring for extremely preterm infants, the provision of information to parents and organisation of neonatal services.
extreme prematurity, necrotising enterocolitis, surgery, outcome, intestinal perforation
F504-F507
Durell, Jonathan
6387b686-bfef-42a1-bb87-114f2ee4af59
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
Drewett, Melanie
65f749d5-0334-4a3b-bd07-f2c32dc46020
Paramanantham, Kujan
2ce5d4d5-69bc-49f7-9b6f-b110a67fceff
Burge, David
17a2f2a5-6228-4192-92df-838e0cccdbe5
November 2017
Durell, Jonathan
6387b686-bfef-42a1-bb87-114f2ee4af59
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
Drewett, Melanie
65f749d5-0334-4a3b-bd07-f2c32dc46020
Paramanantham, Kujan
2ce5d4d5-69bc-49f7-9b6f-b110a67fceff
Burge, David
17a2f2a5-6228-4192-92df-838e0cccdbe5
Durell, Jonathan, Hall, Nigel, Drewett, Melanie, Paramanantham, Kujan and Burge, David
(2017)
Emergency laparotomy in infants born at <26 weeks gestation: a neonatal network based cohort study of frequency, surgical pathology and outcomes.
Archives of Disease in Childhood, 102 (6), .
(doi:10.1136/archdischild-2016-312195).
Abstract
Objective Identify the proportion of infants born at <26 completed weeks’ gestation who require emergency laparotomy, and review the surgical pathology, incidence of subsequent surgical procedures and outcome.
Design Retrospective cohort review.
Setting Tertiary neonatal surgical unit.
Patients All infants born at <26 weeks’ gestation in a neonatal network over an 8-year period.
Results Of 381 infants, laparotomy was indicated in 61 (16%) and performed in 57. Surgical pathology encountered included spontaneous intestinal perforation (SIP) (28), necrotising enterocolitis (NEC) (14), volvulus without malrotation (1), strangulated inguinal hernia (1), milk curd obstruction (4), NEC stricture (1) and meconium obstruction of prematurity (2). No intestinal pathology was found in six. Four infants with indications for laparotomy and severe comorbidity had intensive care withdrawn without surgery. The most frequent procedure performed was resection with primary anastomosis. Nine infants (16%) required more than one laparotomy. Of the 16 infants who had stoma formation, eight had closure before discharge. Fifteen infants required surgical patent ductus arteriosus ligation following laparotomy, and 17 had laser therapy for retinopathy of prematurity. Overall 42 infants with indication for laparotomy (69%) survived to discharge.
Conclusions Nearly one in six infants born at <26 weeks required emergency laparotomy. The most frequent pathology encountered was SIP (49%), followed by NEC (25%). Over one-quarter required subsequent gastrointestinal surgery, with many also requiring cardiothoracic and ophthalmic procedures. These data are important for those caring for extremely preterm infants, the provision of information to parents and organisation of neonatal services.
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Accepted/In Press date: 17 March 2017
e-pub ahead of print date: 3 May 2017
Published date: November 2017
Keywords:
extreme prematurity, necrotising enterocolitis, surgery, outcome, intestinal perforation
Organisations:
Human Development & Health
Identifiers
Local EPrints ID: 406923
URI: http://eprints.soton.ac.uk/id/eprint/406923
ISSN: 0003-9888
PURE UUID: e6b72c3c-ec61-4b6e-b4a7-a71c4dcdbe5e
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Date deposited: 28 Mar 2017 01:05
Last modified: 16 Mar 2024 05:10
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Contributors
Author:
Jonathan Durell
Author:
Melanie Drewett
Author:
Kujan Paramanantham
Author:
David Burge
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