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Inguinal hernia in very low-birthweight infants: Follow up to adolescence
Masashi Kurobe1, Yuji Baba1, Masahiko Otsuka1
1Department of Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan.
Insights
Inguinal hernias (IH) are common in very low-birthweight infants (VLBWI). Observation up to six months may allow spontaneous regression, but surgical repair before ten months is recommended to prevent incarceration.
Area of Science:
- Neonatalogy
- Pediatric Surgery
Background:
- Inguinal hernia (IH) is a common condition in very low-birthweight infants (VLBWI).
- Optimal timing for IH repair in VLBWI remains debated.
- This study investigates IH incidence and management in VLBWI.
Purpose of the Study:
- To review the incidence of inguinal hernias (IH) in very low-birthweight infants (VLBWI).
- To determine the ideal timing for inguinal hernia (IH) repair in very low-birthweight infants (VLBWI).
Main Methods:
- Retrospective review of medical records for 274 VLBWI treated between 1994-1999.
- Inclusion of outpatient data and a 2011 family questionnaire follow-up.
- Analysis of IH diagnosis, incarceration, spontaneous regression, and surgical repair timing.
Main Results:
- IH diagnosed in 39/274 VLBWI during NICU stay; two incarcerated.
- Spontaneous IH regression observed in 18 infants by a mean age of 180 days.
- New IH post-NICU discharge in 25 VLBWI; repair before 10 months advised.
Conclusions:
- High incidence of IH in VLBWI confirmed; low incarceration rate and high spontaneous regression rate.
- Observational approach up to 6 months is a viable option to avoid unnecessary surgery.
- Surgical repair before 10 months recommended to mitigate incarceration risk in VLBWI.
Background:
This study reviewed the medical records of very low-birthweight infants (VLBWI) followed up to adolescence, with emphasis on inguinal hernia (IH), to discuss the ideal time for IH repair in VLBWI.
Methods:
Medical records from 274 VLBWI treated in the neonatal intensive care unit (NICU) between 1994 and 1999 were collected retrospectively. Outpatient data after NICU discharge were included. Additionally, a follow-up study was undertaken via questionnaire sent to the families of VLBWI in 2011.
Results:
During NICU hospitalization, IH was diagnosed in 39 of 274 VLBWI, and two developed incarceration. Thirty-eight VLBWI were discharged with known hernia, and elective repair was performed in 19. Three developed incarceration before elective repair at the mean age of 316 days. In the remaining 18 cases of IH, spontaneous regression occurred at a mean age of 180 days and repair was not performed. New IH appeared in 25 VLBWI after NICU discharge.
Conclusions:
The high incidence of IH in VLBWI was confirmed during follow up to adolescence. The rate of incarceration was low and the incidence of spontaneous regression was high. Observation up to 6 months without surgery, with the expectation of spontaneous regression, is one option to avoid unnecessary surgery, but repair should be performed before 10 months to reduce the risk of incarceration. Further large, prospective, and randomized controlled studies with a long follow up are necessary to validate the present results and to define the ideal time for IH repair in VLBWI.
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