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By Edgar Alzate Cirugía Pediátrica - Universidad Nacional de Colombia
Stephanie Sea, Teerin Meckmongkol, Matthew L Moront, Shaheen Timmapuri, Rajeev Prasad, Marshall Z Schwartz, L Grier Arthur
PURPOSE: Necrotizing enterocolitis (NEC) requiring surgical intervention is associated with mortality rates approaching 50%. We evaluated outcomes of patients that underwent surgical treatment for NEC with vacuum-assisted closure (VAC) of the abdomen as compared with traditional laparotomy, bowel resection, and ostomy creation. METHODS: A retrospective review identified 26 patients from 2007 to 2012 with NEC. Overall, 17 patients were treated with laparotomy, and 9 were treated with laparotomy and VAC (LapVac)...
February 2015: European Journal of Pediatric Surgery
Augusto Zani, Simon Eaton, Prem Puri, Risto Rintala, Marija Lukac, Pietro Bagolan, Joachim F Kuebler, Michael E Hoellwarth, Rene Wijnen, Juan Tovar, Agostino Pierro
AIM: The aim of this study is to define patterns in the management of necrotizing enterocolitis (NEC). METHODS: A total of 80 delegates (81% senior surgeons) from 29 (20 European) countries completed a survey at the European Pediatric Surgeons' Association 2013 annual meeting. RESULTS: Overall, 59% surgeons work in centers where>10 cases of NEC are treated per year. DIAGNOSIS: 76% surgeons request both anteroposterior and lateral abdominal X-rays, which are performed at regular intervals by 66%; 50% surgeons also request Doppler ultrasonography; most frequently used biochemical markers are platelets (99% of surgeons), C-reactive protein (90%), and white cell count (83%)...
February 2015: European Journal of Pediatric Surgery
Mehul V Raval, R Lawrence Moss
Necrotizing enterocolitis (NEC) is the most common surgical emergency occurring in neonatal intensive care unit (NICU) patients. Among patients with NEC, those that require surgery experience the poorest outcomes and highest mortality. Surgical intervention, while attempting to address the intestinal injury and ongoing mulitfactorial physiologic insults in NEC is associated with its own stresses that may compound the ongoing physiologic derangement. Surgery is thus reserved for those patients with clear indication for intervention such as pneumoperitoneum, confirmed stool or pus in the peritoneal cavity, or worsening clinical status...
February 2014: Pathophysiology: the Official Journal of the International Society for Pathophysiology
Mehul V Raval, Nigel J Hall, Agostino Pierro, R Lawrence Moss
Necrotizing enterocolitis remains a common cause of morbidity and mortality in the neonatal period. Despite many advances in the management of the critically ill neonate, the exact etiology, attempts at prevention and determining best treatment for NEC have been elusive. Unfortunately, the overall survival for this poorly understood and complex condition has not improved. NEC is a condition that can and should be studied with randomized prospective trials (RCTs). This chapter reviews the current evidence-based trials for this condition thus far performed...
May 2013: Seminars in Pediatric Surgery
Brandy L Frost, Michael S Caplan
Although smaller and younger preterm neonates can now survive long term due to advances in neonatal medicine, necrotizing enterocolitis (NEC) continues to plague the clinicians caring for these tiny patients. Research studies have contributed to our understanding of this complex disease, including the role of platelet-activating factor (PAF), but preventative and treatment strategies remain limited. One promising preventative measure in recent years has been enteral supplementation of probiotics, but concerns remain regarding the optimal use of these organisms, and safe administration must be assured...
May 2013: Seminars in Pediatric Surgery
Abhijeet Rakshasbhuvankar, Shripada Rao, Corrado Minutillo, Ian Gollow, Satish Kolar
AIM: Perforated necrotising enterocolitis (NEC) and spontaneous intestinal perforation (SIP) in preterm infants are associated with high morbidity and mortality. The optimum surgical management during the acute stage remains unclear. The aim of the study was to compare the outcomes of preterm infants (gestational age at birth <30 weeks) with perforated NEC or SIP undergoing primary peritoneal drainage (PD) versus laparotomy. METHODS: This was a retrospective cohort study (January 2004 to February 2010)...
March 2012: Journal of Paediatrics and Child Health
Shripada C Rao, Laxman Basani, Karen Simmer, Naeem Samnakay, Girish Deshpande
BACKGROUND: Standard surgical management of infants with perforated necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP) is laparotomy with the resection of the necrotic or perforated segments of the intestine. Peritoneal drainage is an alternative approach to the management of such infants. OBJECTIVES: To evaluate the benefits and risks of peritoneal drainage compared to laparotomy as the initial surgical treatment for perforated NEC or SIP in preterm infants...
June 15, 2011: Cochrane Database of Systematic Reviews
Clare M Rees, Simon Eaton, A Kate Khoo, Edward M Kiely, Agostino Pierro
INTRODUCTION: Proponents of peritoneal drainage (PD) hypothesize that it allows stabilization before laparotomy. We examined this hypothesis by comparing clinical status before and after either PD or primary laparotomy (LAP). METHODS: In an ethically approved, international, prospective randomized controlled trial (2002-2006), extremely low birth weight (<1000 g) infants with pneumoperitoneum received primary PD (n = 35) or LAP (n = 34). Physiologic data were collected prospectively and organ failure scores calculated and compared between preprocedure and day 1 after procedure...
February 2010: Journal of Pediatric Surgery
Juan E Sola, Joseph J Tepas, Leonidas G Koniaris
BACKGROUND: To determine whether peritoneal drain (PD) or laparotomy (LAP) is the most effective intervention in premature neonates with necrotizing enterocolitis (NEC) or intestinal perforation (IP). METHODS: A systematic review of the published literature between January 2000 and December 2008 was undertaken. Prospective studies with at least 25 patients in each of the PD and LAP arms were selected. Gestational age, birth weight, operation, and mortality data were extracted...
June 1, 2010: Journal of Surgical Research
R Lawrence Moss, Reed A Dimmitt, Douglas C Barnhart, Karl G Sylvester, Rebeccah L Brown, David M Powell, Saleem Islam, Jacob C Langer, Thomas T Sato, Mary L Brandt, Hanmin Lee, Martin L Blakely, Eric L Lazar, Ronald B Hirschl, Brian D Kenney, David J Hackam, Daniel Zelterman, Bonnie L Silverman
BACKGROUND: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outcomes of primary peritoneal drainage with laparotomy and bowel resection in preterm infants with perforated necrotizing enterocolitis. METHODS: We randomly assigned 117 preterm infants (delivered before 34 weeks of gestation) with birth weights less than 1500 g and perforated necrotizing enterocolitis at 15 pediatric centers to undergo primary peritoneal drainage or laparotomy with bowel resection...
May 25, 2006: New England Journal of Medicine
Martin L Blakely, Jon E Tyson, Kevin P Lally, Scott McDonald, Barbara J Stoll, David K Stevenson, W Kenneth Poole, Alan H Jobe, Linda L Wright, Rosemary D Higgins
OBJECTIVE: Extremely low birth weight (ELBW; < or =1000 g) infants with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP) are treated surgically with either initial laparotomy or peritoneal drain placement. The only published data comparing these therapies are from small, retrospective, single-center studies that do not address outcomes beyond nursery discharge. The objective of this study was to conduct a prospective, multicenter, observational study to (1) develop a hypothesis about the relative effect of these 2 therapies on risk-adjusted outcomes through 18 to 22 months in ELBW infants and (2) to obtain data that would be useful in designing and conducting a successful trial of this hypothesis...
April 2006: Pediatrics
A Zenciroğlu, O Cakmak, N Demirel, A Y Baş, D Yilmaz, I Karaman, D Erdoğan
Perforation of the gastrointestinal tract in neonates is still associated with high mortality rates. Laparotomy is usually required to treat gastrointestinal perforation, however peritoneal drainage under local anesthesia has been also described as an alternative mode of treatment. In our institute, laparotomy was the first choice for the management of gastrointestinal perforation in neonates until 1999. Because of the high mortality rates in this group of patients, our policy has since changed to the use of primary peritoneal drainage instead...
August 2005: European Journal of Pediatric Surgery
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