Mitsuru Muto1, Koshiro Sugita2, Satoshi Ibara3, Ryuta Masuya4, Makoto Matuskubo2, Takafumi Kawano5, Yumiko Saruwatari6, Seiro Machigashira5, Koichi Sakamoto7, Kazuhiko Nakame4, Shin Shinyama8, Motofumi Torikai3, Yoshihiro Hayashida2, Motoi Mukai2, Takamasa Ikee9, Ryuichi Shimono10, Hiroyuki Noguchi5,11, Satoshi Ieiri2. 1. Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, 890-8520, Japan. mitsuru@m3.kufm.kagoshima-u.ac.jp. 2. Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima, 890-8520, Japan. 3. Department of Neonatology, Perinatal Medical Center, Kagoshima City Hospital, Kagoshima, Japan. 4. Department of Surgery, University of Miyazaki Hospital, Miyazaki, Japan. 5. Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan. 6. Yumiko Clinic, Hyogo, Japan. 7. Department of Pediatric Surgery, Oita Prefectural Hospital, Oita, Japan. 8. Department of Pediatric Surgery, Kitakyushu City Yahata Hospital, Fukuoka, Japan. 9. Department of Pediatric Surgery, Saiseikai Sendai Hospital, Kagoshima, Japan. 10. Department of Pediatric Surgery, Kagawa University Hospital, Kagawa, Japan. 11. Nanmeikai Miyagami Hospital, Kagoshima, Japan.
Abstract
PURPOSE: Necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI) are major diseases that cause gastrointestinal disorders in extremely low-birth-weight infants (ELBWIs). We conducted a review to compare the postoperative outcomes of ELBWIs with these diseases in our neonatal intensive-care unit. METHODS: A retrospective chart review of ELBWIs surgically treated for NEC (n = 31), FIP (n = 35), and MRI (n = 16) in 2001-2018 was undertaken. This period was divided into early (2001-2005), middle (2006-2010), and late (2011-2018) periods. Data were analyzed with the Cochran-Armitage test. Statistical significance was defined as p < 0.05. RESULTS: The survival rates in ELBWIs with NEC (early/middle/late: 36.4%/42.9%/61.5%; p = 0.212) and FIP (20%/50%/70.6%; p = 0.012) improved over time; all patients with MRI survived. The neuropsychological development of 24 cases was assessed with the Kyoto Scale of Psychological Development in the Postural-Motor, Cognitive-Adaptative, and Language-Social domains. The mean developmental quotient of all domains was 68.4 (range 18-95) at corrected 1.5 years of age and 69.1 (range 25-108) at chronological 3 years of age, both were considered as poor development. There was no improvement over time (p = 0.899). CONCLUSION: Ideal neuropsychological development was not observed with the improvement of survival rate. Less-invasive surgical intervention and adequate postoperative care are required to encourage further development.
PURPOSE:Necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI) are major diseases that cause gastrointestinal disorders in extremely low-birth-weight infants (ELBWIs). We conducted a review to compare the postoperative outcomes of ELBWIs with these diseases in our neonatal intensive-care unit. METHODS: A retrospective chart review of ELBWIs surgically treated for NEC (n = 31), FIP (n = 35), and MRI (n = 16) in 2001-2018 was undertaken. This period was divided into early (2001-2005), middle (2006-2010), and late (2011-2018) periods. Data were analyzed with the Cochran-Armitage test. Statistical significance was defined as p < 0.05. RESULTS: The survival rates in ELBWIs with NEC (early/middle/late: 36.4%/42.9%/61.5%; p = 0.212) and FIP (20%/50%/70.6%; p = 0.012) improved over time; all patients with MRI survived. The neuropsychological development of 24 cases was assessed with the Kyoto Scale of Psychological Development in the Postural-Motor, Cognitive-Adaptative, and Language-Social domains. The mean developmental quotient of all domains was 68.4 (range 18-95) at corrected 1.5 years of age and 69.1 (range 25-108) at chronological 3 years of age, both were considered as poor development. There was no improvement over time (p = 0.899). CONCLUSION: Ideal neuropsychological development was not observed with the improvement of survival rate. Less-invasive surgical intervention and adequate postoperative care are required to encourage further development.