An Experience with 31 Cases of Neonatal Appendicitis: A Retrospective Study

Abstract

Background: Neonatal appendicitis (NA) is rarely diagnosed due to lack of specific symptoms and signs. The aim of this study is to share our experience with NA.Methods: We performed a retrospective data review from electronic medical records of patients admitted at Children’s Hospital of Chongqing Medical University (CHCMU) with the clinical diagnosis of NA from October 2001 to July 2018.Results: Of 31 neonates, male neonates (n=20) accounted for 64.5%. Abdominal distension and anorexia were the most common clinical features (61.3%, n=19). Neonates with elevated C- reactive protein (CRP) accounted for 92.6% (n=25) where as 51.6% (n=16) had normal white blood cell count (WBC). Of 29 neonates who underwent surgery, 69% (n=20) had perforated appendicitis.Conclusion: Neonatal appendicitis lacks specific clinical features, and early diagnosis is difficult. Clinicians need to have high index of suspicion when attending neonates with features of abdominal sepsis.

Appendicitis in a Newborn: Case Report and Review of the Literature

“…Appendicitis in neonatal population is extremely rare with 141 cases reported since 1905 to 2000 [3]. Incidence is reported to be 0,04% to 0,2% [1,[3][4][5]. Low incidence is attributed to the liquid diet, recumbent position, and funnel shaped appendix with a wide opening into the cecum [2].…”

“…These factors lead to a low risk of luminal obstruction, fecaliths [1]. Neonatal appendicitis affects premature and term neonates equally [2,4]. Mortality was reported to be 28% in 2003 [3].…”

“…Speculation exists that mortality is actually lower however no comprehensive studies exist [5]. In fact, a 2019 study published 31 cases of neonatal appendicitis and no deaths occurred [4]. Boys are affected in more than half of the cases [2,4].…”

“…In fact, a 2019 study published 31 cases of neonatal appendicitis and no deaths occurred [4]. Boys are affected in more than half of the cases [2,4]. Incidence of perforation is reported between 69% and 85% [2-4] and seems to be the major point for diagnosis, correlating with increased survival by leading to a faster intervention [2][3][4].…”

“…Boys are affected in more than half of the cases [2,4]. Incidence of perforation is reported between 69% and 85% [2-4] and seems to be the major point for diagnosis, correlating with increased survival by leading to a faster intervention [2][3][4]. The anatomically thin appendiceal wall, nondistensible cecum, low incidence of lymphatic hyperplasia and long mesentery is thought to be the reason why the rates of perforation are higher in neonates than older children [1,3].…”