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Risk factors and prevention for surgical intestinal disorders in extremely low birth weight infants

Masaya Yamoto1, Yusuke Nakazawa2, Koji Fukumoto3

  • 1Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan. smashace1018@yahoo.co.jp.

Pediatric Surgery International
|July 28, 2016
PubMed

Insights

Enteral antifungal prophylaxis (EAP) reduced surgical intestinal disorders (SID) like necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) in extremely low birth weight (ELBW) infants. However, survival after NEC surgery in ELBW infants remains poor.

Area of Science:

  • Neonatal surgery
  • Pediatric gastroenterology
  • Infectious disease prevention

Background:

  • Surgical intestinal disorders (SID), including necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI), are significant causes of morbidity in extremely low birth weight (ELBW) infants (<1000 g).
  • Enteral antifungal prophylaxis (EAP) has been implemented since 2010 to prevent SID in ELBW infants.

Purpose of the Study:

  • To identify disease-specific risk factors for SID in ELBW infants.
  • To evaluate the efficacy of EAP in preventing SID in this vulnerable population.

Main Methods:

  • A retrospective chart review was conducted on 323 consecutive ELBW infants admitted between January 2006 and March 2015.
  • Infants were analyzed for the incidence of NEC, FIP, and MRI, with a control group of non-SID cases.

Main Results:

  • The incidence of NEC, FIP, and MRI was 9, 12, and 13 cases, respectively, with 28 deaths among 323 ELBW infants.
  • In-hospital mortality was higher in infants with NEC compared to controls.
  • Logistic regression identified low gestational age and cardiac malformations as NEC risk factors, and intrauterine growth restriction (IUGR) as an MRI risk factor.
  • EAP was found to decrease the risk of NEC and FIP. Low gestational weight and NEC were associated with increased mortality risk.

Conclusions:

  • Survival following surgical intervention for NEC in ELBW infants remains a critical challenge.
  • EAP demonstrates a preventative effect against NEC and FIP in ELBW infants, highlighting its potential role in reducing SID incidence.
Abstract

Keywords:
Enterally antifungal prophylaxisExtremely low birth weight infantsFocal intestinal perforationMeconium-related ileusNecrotizing enterocolitisSurgical intestinal disorders

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