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[Prognosis of surgery performed in premature infants with birth weights below 1500 gram]
E Waever1, B Brandt, T Mortensen
1Børnekirurgisk Afdeling GK, Rigshospitalet, København.
Insights
Extremely low birth weight infants tolerate anesthesia and surgery well. Survival is impacted by congenital anomalies and necrotizing enterocolitis, not surgical procedures themselves.
Area of Science:
- Neonatal surgery
- Pediatric anesthesia
- Intensive care medicine
Context:
- Improved neonatal intensive care has increased survival rates for very low birth weight infants.
- A significant number of these infants require surgical intervention for congenital anomalies or necrotizing enterocolitis.
- Necrotizing enterocolitis presents a growing challenge in neonatal units.
Purpose:
- To evaluate the safety and outcomes of anesthesia and surgery in infants weighing under 1,500 grams.
- To analyze mortality causes in relation to surgical procedures and underlying conditions.
- To identify prognostic factors influencing survival in this vulnerable population.
Summary:
- A retrospective analysis of 24 infants under 1,500 grams who underwent surgery between 1981 and 1988 was conducted.
- Infants tolerated anesthesia and surgery well, irrespective of their extremely low birth weight.
- Mortality in the congenital anomaly group (43%) and necrotizing enterocolitis group (40%) was not attributed to anesthesia or surgical trauma, but to sepsis in the latter.
- Unfavorable prognostic factors included low Apgar scores and preoperative weight loss in the necrotizing enterocolitis group.
Impact:
- Demonstrates the feasibility and relative safety of surgical interventions in extremely low birth weight neonates.
- Highlights the critical role of managing sepsis and identifying prognostic indicators for improved outcomes.
- Informs clinical decision-making regarding surgical risks and benefits for neonates with complex conditions.
Abstract:
On account of improved management in neonatal intensive care units, the survival rate is presently nearly 50% in babies with birth weights below 1,000 grams and 80% in the group with birth weights from 1,000 to 1,500 grams. A number of these babies require surgery, either for correction of congenital anomalies or for acquired necrotizing enterocolitis, which is an increasing burden in neonatal units. The present analysis of 24 babies weighing under 1,500 grams, operated on in the period 1981 to 1988 confirms that even extremely small babies tolerate the performed anesthesia and surgery well. In the group with anomalies (7 of 24) three died (43%). The causes of death do not appear to be related to the anesthesia or surgery. In the group with necrotizing enterocolitis (15 of 24) six died (40%). The cause of death was directly related to the septic condition in all cases, and the surgical trauma does not appear to have any negative influence. Unfavourable prognostic factors in this group were low Apgar scores within the first minute and preoperative weight loss.