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Predictors for surgical intervention and surgical outcomes in neonates with cystic fibrosis
Samuel Jessula1, Michiel Van Den Hof2, Dimas Mateos-Corral3
1Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
Insights
Prematurity and lower birthweight increase the risk of meconium ileus (MI) and surgery in newborns with cystic fibrosis (CF). Specific genetic factors and prenatal echogenic bowel were not found to be predictors.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Genetics of cystic fibrosis
Background:
- Meconium ileus (MI) is a significant early manifestation of cystic fibrosis (CF).
- Identifying predictors of MI and surgical intervention is crucial for timely management.
Purpose of the Study:
- To determine prenatal and perinatal risk factors for meconium ileus (MI) in neonates with cystic fibrosis (CF).
- To describe the surgical findings and outcomes for neonates with MI secondary to CF.
Main Methods:
- Retrospective cohort study of neonates with CF from 1997-2015.
- Analysis of risk factors including prenatal echogenicity, CF genotype, birthweight, prematurity, and sex.
- Multivariable logistic regression to identify predictors of MI and surgery.
Main Results:
- 21.7% of neonates with CF developed MI; 73% of those required surgery.
- Prematurity and lower birthweight were significant predictors of MI and surgical intervention (p<0.05).
- Surgical findings included atresia in 4/17 and ostomy in 6/17; median NICU stay was 34.5 days.
Conclusions:
- Prematurity and lower birthweight are key risk factors for MI and surgery in CF neonates.
- Prenatal echogenic bowel and specific CF genotypes were not predictive of MI or surgical need.
Background/Purpose:
To identify prenatal and perinatal predictors of surgery and describe surgical findings/outcomes of neonates with Meconium Ileus (MI) secondary to Cystic Fibrosis (CF).
Methods:
Potential risk factors (prenatal bowel echogenicity, CF genotype, birthweight, prematurity and sex) for MI and surgery were examined in a retrospective cohort of neonates with CF presenting to a tertiary center between 1997 and 2015. Following univariable analysis, predictors of MI and surgery were determined using multivariable logistic regression. For surgical patients, detailed operative findings and outcomes were examined.
Results:
MI was diagnosed in 26/120 (21.7%) neonates with CF and 19/26 (73.0%) required surgery. Prematurity was significantly associated with increased risk of MI and operative intervention (p-value 0.022 and p-value 0.016 respectively); lower birthweight was associated with operative intervention (p-value 0.039); genotype and echogenic bowel were associated with neither. Surgical data were available for 17/19 patients; median age at surgery was 2 days (IQR1-3), 4/17 had an atresia and 6/17 received an ostomy. Median NICU and hospital stays were 34.5 and 70 days while median time on TPN and time to ostomy reversal were 28.5 and 97 days, respectively.
Conclusions:
In patients with CF, prematurity and lower birthweight were identified as risk factors for meconium ileus and need for surgery. Specific genotypes and echogenic bowel were not predictors of either.
Level Of Evidence:
Level III.
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