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Oral Presentation - 15
Early versus late duodenal atresia repair in preterm and low birth neonates - a single centre experience
Mohamed Ali, Tristan Boam, Sri Paran
Children's Health Ireland, Dublin, Ireland
Background
Duodenal atresia (DA) is a mainstay of the acute neonatal surgical take; duodenoduodenostomy is an essential procedure for the attending paediatric surgeon. However, management of DA in extremely low birth weight (ELBW, <1.5 kg) and very preterm neonates (<32 weeks gestation) is a topic of controversy, some surgeons advocate for delayed repair to minimise risks of bile duct injury, others prefer early repair, to avoid risks associated with long term parenteral nutrition.
Purpose
This study aims to compare the outcomes of early versus late surgical intervention for duodenal atresia in preterm infants weighing less than 1.5 kg and/or born before 32 weeks of gestation.
Methods
A retrospective 20-year case review (2004-2024) was undertaken of all preterm and/or low birth weight DA patients undergoing surgery at a single tertiary centre. Patients undergoing surgery within the first week of life were compared to those operated after 1 week. Key outcome measures included postoperative complications, time to full enteral feeding, length of hospital stay, and mortality.
Results
Sixteen neonates were identified with a median gestational age of 30+5 weeks and birth weight of 1.42kg. Infants born ≤32weeks represented 14.8% the cohort. Increasing corrected gestational age at surgery was associated with decreased morbidity, while decreasing DOL at surgery was associated with increased morbidity. In the propensity score matched analysis of premature neonates, delayed repairs were associated with increased postoperative ventilation
Conclusion
Management of DA repair in preterm and low birth weight neonates is controversial. While delaying surgery does not appear to mitigate the risks associated with prematurity, it may lead to prolonged ventilation, hospitalisation and long term parenteral nutrition. The study suggests that surgical repair around 32 weeks gestational age may be reasonable for neonates without prohibitive risk factors.