Late-onset volvulus without malrotation in extremely preterm infants--a case-control-study.

Area of Science:

• Neonatalogy
• Pediatric Surgery
• Gastroenterology

Background:

• Volvulus without malrotation is a rare, potentially fatal condition in preterm infants.
• It can be misdiagnosed as necrotizing enterocolitis, delaying critical surgical intervention.
• The etiology and specific risk factors remain unclear.

Purpose of the Study:

• To identify risk factors for volvulus without malrotation in preterm infants.
• To characterize the clinical presentation of this condition.
• To differentiate it from necrotizing enterocolitis.

Main Methods:

• Retrospective, single-center case-control study.
• Compared 5 preterm infants with volvulus to 5 controls matched for gestational age, birth weight, and birth year.
• Also evaluated 9 cases of necrotizing enterocolitis.

Main Results:

• Five extremely premature infants (24.4 weeks GA, 480g BW) with volvulus were identified; all were small for gestational age and female.
• Volvulus occurred weeks after birth, unlike necrotizing enterocolitis which presented earlier.
• Infants with volvulus had more rectal tube manipulations and higher respiratory support (nasal high-frequency oscillation, PEEP).

Conclusions:

• Volvulus without malrotation is a severe condition in extremely premature infants, typically presenting weeks post-birth with acute abdomen.
• Predominantly affects female infants.
• Intensive non-invasive respiratory support may indicate a higher risk.