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The impact of surgery on infants born at extremely low birth weight
Jonathan N Limpert1, Patricia A Limpert, Thomas R Weber
1Department of Surgery, Cardinal Glennon Children's Hospital, St Louis, MO 63104, USA.
Insights
Surgical interventions for extremely low-birth-weight infants (ELBW) did not increase mortality or morbidity. These findings support an aggressive approach to managing ELBW infants with prematurity complications.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Perinatal Medicine
Background:
- Extremely low-birth-weight (ELBW) infants (<1,000 g) face significant risks from prematurity complications.
- Surgical interventions are sometimes necessary for these high-risk infants.
- The impact of surgery on outcomes for ELBW infants requires careful evaluation.
Purpose of the Study:
- To determine the outcomes of extremely low-birth-weight (ELBW) infants who underwent surgical interventions for complications of prematurity.
- To compare the outcomes of ELBW infants requiring surgery versus those who did not.
Main Methods:
- A retrospective review of 187 consecutive infants with birth weight <1,000 g over a 5-year period.
- Data collected included surgical procedures, length of stay, survival rates, and pulmonary, neurologic, and gastrointestinal morbidity.
- Infants were categorized into surgical (Group S) and non-surgical (Group NS) groups.
Main Results:
- Surgical intervention was required in 35% of ELBW infants, primarily for necrotizing enterocolitis/bowel perforation, patent ductus arteriosus, and other conditions.
- Overall mortality rates were similar between the surgical (23%) and non-surgical (22%) groups (P > .05).
- Mortality was higher for infants undergoing surgery for necrotizing enterocolitis/bowel perforation (38%, P < .05). Neurologic and pulmonary morbidity rates did not differ significantly between groups.
Conclusions:
- Outcomes for ELBW infants appear to be improving.
- Common morbidities associated with prematurity do not seem to be adversely affected by surgical interventions.
- These findings support an aggressive management approach for ELBW infants facing life-threatening conditions.
Purpose:
The aim of this study was to determine the outcome of extremely low-birth-weight infants (ELBW) requiring surgical interventions for the complications of prematurity
Methods:
One hundred eighty-seven consecutive infants with a birth weight less than 1,000 g treated over a 5-year period were reviewed. Outcome variables included number and types of surgical procedures; length of stay; survival rate and; pulmonary, neurologic, and gastrointestinal morbidity.
Results:
Surgical interventions were required in 66 (35%) infants (group S) weighing less than 1,000 g at birth (33% necrotizing enterocolitis/bowel perforation, 36% patent ductus arteriosus, 56% other). Overall mortality rate for group S infants was 23% compared with 22% for those not requiring surgery (group NS; P >.05). Mortality rate rose to 38% for those infants undergoing procedures for necrotizing enterocolitis/bowel perforation (P <.05). Although neurologic and pulmonary morbidity for the entire population were high, there was no difference in their incidence between surgical and nonsurgical groups (29% v 26% and 44% v 65%, group S v group NS, respectively; P >.05).
Conclusions:
These data suggest an improving outcome for ELBW infants. Common associated morbidities of prematurity do not appear adversely affected by surgical interventions supporting an aggressive approach to the care of these infants at the extreme of life.