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TÜRKÇE
Poster - 359
Neonatal gastrointestinal perforation; causes, surgical techniques and factors affecting survival
Muhammed Hamidullah Çakmak, Özlem Balcı, Betül Gürbüz, Sabri Cansaran, Serdar Moralıoğlu, Ayşenur Celayir
University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Department of Pediatric Surgery, Istanbul Zeynep Kamil Women and Children’s Diseases Health Training and Research Center
Purpose: Gastrointestinal perforation (GIP) is a life-threatening condition and a surgical emergency in neonates. The most common cause is necrotizing enterocolitis (NEC). Approximately one in two extremely low birth weight (ELBW) infants who underwent surgery for NEC or SIP died. Herein, we aimed to evaluate the aetiology, surgical procedures and factors affecting survival in newborns diagnosed with GIP.
Method: Neonates affected by a primary GIP in the last 10 years period were reviewed retrospectively. Demographic data, details of surgical procedures, outcomes and survival rates were evaluated.
Results: A total of 108 neonates (63 males and 45 females) were evaluated. The median gestational age was 29 weeks and 38% were extremely preterm. The median birth weight was 1245 gr and 42.6% had ELBW. Initial bedside drainage was performed in the NICU in 79.6% of patients, while laparotomy was performed in 83.3%. The mortality rate of newborns who underwent PD was higher than those who did not receive PD (p<.001). NEC was the most common cause of perforation that effects 61.1% of the patients. Other common causes were intestinal atresia (13.0%), spontaneous intestinal perforation (10.2%) and gastric perforation (6.5%). Regarding the details of surgical techniques, enterostomy, bowel resection and suturing/closure were performed in 34 (39.2%), 39 (43.8%) and 13 (14.6%) newborns, respectively. Our mortality rate was 40.7%. The most important factors affecting mortality with statistical significance were low birth weight and gestational age.
Conclusion: Despite all the developments in NICU, low birth weight and prematurity are still the most important causes of mortality. Since our hospital is a perinatology and newborn reference centre and the majority of our patients are ELBW and extremely preterm newborns, our GIP mortality rate was found to be high. Therefore, the most important treatment is to protect patients from intestinal perforation.