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Postoperative outcome in premature infants with open abdomen
A Lambertz1, M Binnebösel, A Röth
1Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany, alambertz@ukaachen.de.
Insights
Outcomes for premature infants with an open abdomen depend on a complication-free postoperative course, not initial conditions. Postoperative anemia is a significant negative prognostic factor for survival in these complex pediatric surgical patients.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Surgical Outcomes Research
Background:
- Premature infants undergoing laparostomy (open abdomen) face high morbidity and mortality.
- Laparostomy involves intentionally leaving the anterior peritoneal cavity open.
- This study investigates factors affecting outcomes in this vulnerable patient group.
Purpose of the Study:
- To identify key factors influencing the postoperative outcomes of premature infants treated with an open abdomen.
- To analyze the impact of various clinical parameters on survival rates.
Main Methods:
- Retrospective analysis of 40 premature infants treated with open abdomen between 2002 and 2012.
- Patients were categorized into survival and non-survival groups.
- Key variables included gestational age, birth weight, surgical indication, and postoperative complications.
Main Results:
- Overall in-hospital mortality was 43%.
- Postoperative anemia was the sole significant factor linked to mortality (p=0.028).
- Surgical indication, gestational age, and birth weight did not significantly impact survival.
Conclusions:
- Postoperative outcomes in premature infants with open abdomen are more influenced by a smooth postoperative course than preoperative status.
- Postoperative anemia emerges as a critical negative prognostic marker.
- Successful fascia closure is strongly associated with patient survival.
Background:
Premature infants treated with laparostomy in the first days of their life represent a group of complex patients with high morbidity and mortality rates. Laparostomy is a surgical treatment method in which the peritoneal cavity is opened anteriorly and deliberately left open, hence often called "open abdomen". The aim of this study was to analyze crucial factors influencing the postoperative outcome of premature infants treated this way.
Methods:
Between March 2002 and August 2012, we treated 40 premature infants with a median gestational age of 29 weeks (range from 24 to 34 weeks) with open abdomen in our institution. Their data were analyzed retrospectively. They were divided into two groups depending on in-hospital survival.
Results:
Indications for surgery were ileus (n = 16), spontaneous intestinal perforation (n = 11), gastroschisis (n = 8) and necrotizing enterocolitis (NEC, n = 5). The overall in-hospital mortality was 43 % (17 of 40 patients). Postoperative anemia was the only significant factor influencing mortality rates in our patients (10 vs. 14 patients; p = 0.028). Neither the indication of surgery, nor week of gestation, nor birth weight had any significant influence on postoperative survival. Twenty-one of the 23 surviving patients reached fascia closure.
Conclusions:
In our study, outcome of premature infants with open abdomen in the first days of their life seems to depend more on an operation and a postoperative course without complications than on the preoperative conditions of the children. Postoperative anemia seems to be a significant negative prognostic marker. Patients reaching fascia closure mainly survive.
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