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Neonatal intestinal obstruction
H M Reyes1, J L Meller, D Loeff
1Department of Surgery, Cook County Hospital, Chicago, Illinois.
Insights
Neonatal intestinal obstruction management is effective with specialized care, achieving low mortality. Key factors for survival include prompt diagnosis and intervention, with prematurity not significantly impacting outcomes.
Area of Science:
- Pediatric Surgery
- Neonatology
Background:
- Intestinal obstruction is a critical condition in neonates.
- Effective management requires adherence to specific diagnostic and treatment principles.
Purpose of the Study:
- To outline key principles in diagnosing and managing neonatal intestinal obstruction based on extensive clinical experience.
- To highlight factors influencing survival rates and identify major risk factors.
Main Methods:
- Retrospective analysis of 138 infants with various causes of intestinal obstruction.
- Review of diagnostic modalities including plain abdominal films and contrast studies.
- Evaluation of surgical techniques and collaborative care approaches.
Main Results:
- Achieved an overall mortality rate below 5% through specialized care.
- Prematurity did not significantly affect outcomes; premature infants tolerated surgery well.
- Delayed diagnosis and operative intervention, particularly for midgut volvulus, are major risk factors.
- Chromosome abnormalities represent an additional risk factor.
- Traditional diagnostic studies proved effective; Hirschsprung's disease is diagnosable neonatally with high suspicion.
- Specialized surgical techniques and the Wangensteen-Rice evaluation for imperforate anus are effective.
Conclusions:
- Multidisciplinary collaborative care involving neonatologists, pediatric anesthesiologists, and pediatric surgeons is crucial for favorable outcomes.
- Adherence to established diagnostic and surgical principles can minimize morbidity and mortality in neonatal intestinal obstruction.
Abstract:
Our experience in the management of 138 infants with various causes of intestinal obstruction has provided us with important principles of diagnosis and treatments that we adhere to in the course of our practice. 1. The overall mortality of neonates suffering from intestinal obstruction should be fewer than 5 per cent. The high survival rate is accounted for by improved care these patients receive in specialized units. 2. Prematurity did not appear to play a significant factor in the outcome of these infants with intestinal obstruction. Our experience shows that premature infants tolerate operative procedures well, even in those instances in which an associated surgically correctable lesion is simultaneously repaired. 3. The major risk factor in any neonate with intestinal obstruction is the delay in diagnosis and operative intervention, especially in infants diagnosed to have midgut volvulus. The additional second risk factor is the association of chromosome abnormality. 4. Traditional diagnostic studies such as plain films of the abdomen supplemented by either an upper GI or lower GI contrast study for specific indications have been very effective in obtaining an accurate diagnosis of intestinal bowel obstruction. 5. Hirschsprung's disease can be diagnosed in the neonatal period if the index of suspicion for this is high. 6. Special surgical techniques as described should be used whenever indicated to minimize morbidity. 7. The traditional Wangensteen-Rice evaluation of a patient with imperforate anus is accurate, and specialized studies should be deferred for the postoperative period. Collaborative care provided by the neonatologist, pediatric anesthesiologist, and pediatric surgeon for these patients is the key to a favorable outcome.