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Outcomes of surgery for necrotizing enterocolitis and spontaneous intestinal perforation in Finland during 1986-2014.
Karila, Kristiina; Anttila, Annaleena; Iber, Tarja; Pakarinen, Mikko; Koivusalo, Antti.
Afiliación
  • Karila K; Children's Hospital, University of Helsinki, Finland. Electronic address: kristiina.karila@hus.fi.
  • Anttila A; Children's Hospital, University of Tampere, Finland. Electronic address: Annaleena.Anttila@pshp.fi.
  • Iber T; Children's Hospital, University of Tampere, Finland. Electronic address: iber.tarja@pshp.fi.
  • Pakarinen M; Children's Hospital, University of Helsinki, Finland. Electronic address: mikko.pakarinen@hus.fi.
  • Koivusalo A; Children's Hospital, University of Helsinki, Finland. Electronic address: antti.koivusalo@hus.fi.
J Pediatr Surg ; 53(10): 1928-1932, 2018 Oct.
Article en En | MEDLINE | ID: mdl-30122449
BACKGROUND: Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are the most common abdominal surgical conditions in preemies. Associated mortality remains high and long periods of parenteral nutrition (PN) may be required. We assessed the developments in the outcomes of surgically treated NEC and SIP in the two largest Finnish neonatal intensive care units (NICU). METHODS: Retrospective observational study based on hospital records during 1986-2014. Main outcome measures were three-month survival during 1986-2000 compared with 2001-2014 and predictors of mortality. RESULTS: Included were 225 patients (NICU A 131 and NICU B 94) with NEC in 142 (63%) and SIP 83 (37%). The median birth weight (BW) (870 vs 900 g) and gestation age (GA) (27 vs 27 weeks, p = 0.96) were similar in NEC and SIP. Small intestine was affected in 85% of NEC and 76% of SIP patients (p = 0.12). In 5% of patients NEC was panintestinal. Median small intestinal loss was 25% in NEC and 4.0% in SIP (p < 0.001). Ileocecal valve was resected in 29% of NEC and 14% of SIP patients (p = 0.01). Enterostomy was performed in 78% of patients and primary anastomosis in 18%; 4% died of extensive NEC without definitive surgery. Overall survival was 74% (NEC 73%, SIP 77%, p = 0.48; NICU A 82%, NICU B 65%, p = 0.003). From 1986-2000 to 2001-2014 overall survival increased from 69 to 81% (p = 0.04). Treating NICU was the strongest predictor of survival, RR = 2.8 (95% CI = 1.4-5.1), p = 0.003. CONCLUSIONS: Overall survival improved significantly from the early (1986-2000) to the late (2001-2014) study period. Strongest predictor of mortality was the treating neonatal intensive care unit. LEVEL OF EVIDENCE: III.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enterocolitis Necrotizante / Perforación Intestinal Tipo de estudio: Observational_studies / Prognostic_studies Límite: Humans / Newborn País/Región como asunto: Europa Idioma: En Revista: J Pediatr Surg Año: 2018 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Enterocolitis Necrotizante / Perforación Intestinal Tipo de estudio: Observational_studies / Prognostic_studies Límite: Humans / Newborn País/Región como asunto: Europa Idioma: En Revista: J Pediatr Surg Año: 2018 Tipo del documento: Article Pais de publicación: Estados Unidos