No abstract

Background: NEC is a leading cause of mortality and morbidity in extremely low birth weight (ELBW) infants. The primary aim of the study was to evaluate the risk factors for surgical NEC in ELBW infants, and the second goal was to find out post-operative complications, with specific emphasis on stoma related complications. Methods: A retrospective analysis of surgically treated NEC during the 20-year period from 2001-2020 in a single-center was performed. Postoperative complications were classified according to the Clavien-Dindo Classification (CDC). Patients were divided into 2 groups according to birth weight: ELBW (birth weight ≤ 1000 g) and VLBW (very low birth weight ≤ 1500 g). Results: A total of 97 patients meet the pre-determined eligibility criteria and were included in the study. The proportion of male infants in the ELBW was significantly higher than in VLBW group, (odd ratio [OR] = 5.54 [95% CI, 1.68-14.38]; p = 0.003). Lower Apgar score (AS) in the 1 minute in the ELBW group was significantly associated with the NEC progression (p ˂ 0.001). Stoma creation was more often used in the ELBW than in VLBW group (OR = 4.571 [95% CI, 1.186-16.11]; p =0.023). A total of 49 (72%) infants had postsurgical complication, which was significant greater in the ELBW 44/50 (88%) than the VLBW group 5/18 (27.78%) (OR = 19.07 [95% CI, 4.669-77.09]; p˂ 0.0001). In total, 22 out of 40 ELBW infants with enterostomy (55%) had at least one stoma complication. The overall rate of mortality (CDC: V) was 25/68 patients (36.7%). There was nonsignificant difference between the 2 groups regarding the mortality rate (p = 0.406). Conclusions: Our results showed that the risk factors associated with the surgical NEC in ELBW infants include low birth weight, low gestational age, male gender, and low AS in 1 minute. ELBW infants had a higher complication rate and most of them required reoperation. The type of stoma configuration had no impact on the complication rate. Mortality rate was not affected by the birthweight.

Congenital chylous ascites (CCA) is a rare condition seen in the neonatal period. The pathogenesis is primarily related to congenital intestinal lymphangiectasis. Conservative treatment of chylous ascites involves paracentesis, total parenteral nutrition (TPN), medium-chain triglyceride (MCT)-based milk formula, use of somatostatin analogue and octreotide. Surgical treatment is considered when conservative treatment fails. We describe a laparoscopic treatment of CCA using the fibrin glue technique. A male infant, in whom foetal ascites was detected at 19 weeks of gestation, was born by caesarean section at 35 weeks of gestation weighing 3760 g. There was evidence of hydrops in the foetal scan. A diagnosis of chylous ascites was made by abdominal paracentesis. A magnetic resonance scan was suggestive of gross ascites, and no lymphatic malformation was identified. TPN and octreotide infusion was started and continued for 4 weeks, but the ascites persisted. The failure of conservative treatment led us to perform laparoscopic exploration. Intraoperatively, chylous ascites and multiple prominent lymphatic vessels around the root of the mesentery were noted. The fibrin glue was applied over the leaking mesenteric lymphatic vessels in the duodenopancreatic region. Oral feeding was started from post-operative day 7. After 2 weeks of the MCT formula, ascites progressed. Thus, laparoscopic exploration was necessary. We introduced an endoscopic applicator for fibrin glue and applied it into the place of leakage. The patient was doing well with no appearance of ascites reaccumulating and was discharged on the 45th post-operative day. Follow-up ultrasonography (1st, 3rd and 9th months after discharge) showed a small amount of ascitic fluid but with no clinical significance. Laparoscopic localisation and ligation of leakage sites could be difficult, especially in newborns and young infants due to the small size of lymphatic vessels. The use of fibrin glue to seal the lymphatic vessels is quite promising.