Department of Pediatric Surgery and Urology, University Children's Hospital, Tübingen, Germany.
Neonatology. 2012;101(4):285-92. doi: 10.1159/000335325. Epub 2012 Jan 27.
Necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) are major causes of morbidity in infants with extremely low birth weight (ELBW).
To evaluate the surgical procedures applied, and the survival and long-term outcome of ELBW infants with NEC and FIP in a single-center study.
Inborn and outborn ELBW infants (<1000 g) with NEC and FIP were analyzed retrospectively from 2002 to 2007. Data collected include surgical procedures, survival as well as complications, length of partial parenteral nutrition and hospital stay. The short-term and long-term outcomes after 2-7 years were assessed and compared with a matched control group.
Out of 280 ELBW infants, 28 underwent surgery, 19 because of FIP and 9 for NEC. Fourteen infants in the FIP group were treated with primary laparotomy and 5 with peritoneal drainage (PD). In the NEC group, only 1 infant was treated with PD. PD was used for unstable patients and was always followed by secondary laparotomy after stabilization. Five of 28 (18%) surgically treated ELBW infants and 4 (14%) matched controls died. The following complications occurred in the surgical group: complete (n = 1) or minor wound dehiscence (n = 4), stoma prolapse (n = 5), parastomal hernia (n = 2), stoma fistula (n = 1), and wound infection (n = 2). Dependency on parenteral nutrition was significantly shorter in infants with FIP, while there were no differences in time to stoma closure and length of hospital stay between those with FIP and those with NEC. Eleven of 23 (47.8%) surviving patients with FIP or NEC showed developmental delay, compared with 9 of 24 (37.5%) in the controls.
The management of EBLW infants with NEC and FIP remains challenging. Our treatment approach was associated with low mortality. Developmental delay seems to be caused by extreme prematurity rather than NEC- or FIP-related bowel perforation.
坏死性小肠结肠炎（NEC）和局灶性肠穿孔（FIP）是极低出生体重儿（ELBW）发病和死亡的主要原因。
评估单一中心研究中患有 NEC 和 FIP 的 ELBW 婴儿的手术治疗方法以及生存率和长期预后。
回顾性分析了 2002 年至 2007 年期间出生于本院和外院的患有 NEC 和 FIP 的 ELBW 婴儿。收集的数据包括手术治疗方法、存活率以及并发症、部分肠外营养时间和住院时间。通过短期和长期评估比较 2-7 年后的结果，并与匹配的对照组进行比较。
在 280 例 ELBW 婴儿中，28 例行手术治疗，其中 19 例因 FIP，9 例因 NEC。FIP 组中有 14 例婴儿行剖腹探查术，5 例行腹腔引流术（PD）。在 NEC 组中，仅 1 例行 PD。PD 用于不稳定患儿，在稳定后，总是行二次剖腹探查术。28 例手术治疗的 ELBW 婴儿中 5 例（18%）和 4 例（14%）匹配的对照组死亡。手术组出现以下并发症：完全（n=1）或轻微切口裂开（n=4）、造口脱垂（n=5）、切口疝（n=2）、造口瘘（n=1）和伤口感染（n=2）。FIP 患儿的肠外营养依赖时间明显短于 NEC 患儿，而 FIP 患儿与 NEC 患儿的造口关闭时间和住院时间无差异。23 例 FIP 或 NEC 存活患儿中 11 例（47.8%）存在发育迟缓，而 24 例对照组患儿中 9 例（37.5%）存在发育迟缓。
ELBW 婴儿的 NEC 和 FIP 管理仍然具有挑战性。我们的治疗方法与低死亡率相关。发育迟缓似乎是由极度早产引起的，而不是 NEC 或 FIP 相关的肠穿孔引起的。
