Portal venous air: the poor prognosis persists

Area of Science:

• Neonatalogy
• Pediatric Surgery
• Gastroenterology

Background:

• Portal vein air (PVA) presence in neonates with necrotizing enterocolitis (NEC) has a debated prognostic significance.
• Previous studies have not definitively established whether surgical or medical management yields better outcomes for NEC with PVA.

Purpose of the Study:

• To compare the outcomes of surgical versus medical management in infants diagnosed with NEC and PVA.
• To evaluate the prognostic implications of PVA in neonates with NEC.

Main Methods:

• A retrospective analysis of 40 neonates with PVA and NEC admitted to the NICU between 1995 and 1999.
• Data collected included gestational age, birth weight, and survival rates based on operative versus nonoperative treatment strategies.

Main Results:

• The study included 40 neonates with an average gestational age of 26 weeks and birth weight of 1,173g.
• PVA was associated with significant morbidity, including 80% with pneumatosis intestinalis and 20% with perforations. Overall operative mortality was 54% (17/31).
• While 3 of 9 nonoperatively managed patients survived, 6 progressed and died before salvage surgery, indicating limited success with nonoperative approaches.

Conclusions:

• Portal vein air in NEC is a strong indicator of poor prognosis, even with surgical intervention.
• Nonoperative management is associated with high mortality, particularly in patients with acidosis or hemodynamic instability.
• The findings support the view that PVA generally signifies a severe condition requiring careful management, with surgery often necessary despite its risks.