Nonoperative treatment of neonatal appendicitis

Neonatal appendicitis (NA) is a rare but potentially fatal condition with diagnostic challenges and limited management evidence. This study evaluates the efficacy of nonoperative treatment compared to surgical intervention.

A retrospective study included infants ≤ 28 days with clinically and sonographically confirmed NA treated at four institutions between January 2010 and May 2022. The nonoperative group received antibiotics and supportive care, compared to a control group of 34 surgically treated neonates. The primary outcome was nonoperative treatment failure (death or delayed appendectomy), while secondary outcomes included severe infectious complications, hospital stay, costs, and readmission.

Twenty-eight neonates (median age 11 days; 35.7% female) received nonoperative therapy. The failure rate was 25%, with 3 deaths (10.7%) and 5 delayed appendectomies (17.9%). Severe infectious complications occurred in 28.6% of cases, higher than the surgical group, but not statistically significant (P = 0.10). Hospital costs were significantly lower for the nonoperative group (P < 0.05). No recurrence was observed over 6.2 years of follow-up.

Nonoperative treatment of NA was associated with a high failure rate, mortality, and complication rate, despite lower costs. Given limited power for several comparisons, our findings suggest early surgical intervention may be preferable.