Colonic Perforation after Exchange Transfusion

Corkery, J.J.; Dubowitz, Victor; Lister, James; Moosa, A.

doi:10.1136/bmj.4.5627.345

Cited by 70 publications

(8 citation statements)

References 10 publications

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“…Abdominal distension was observed by Farquhar and Smith (1958) in 3 babies after exchange transfusion. Perforation of the colon after this procedure has been reported by Corkery et al (1968) and by Orme and Eades (1968), who also described this complication in a baby given dextrose by umbilical vein catheter for 7 days. Toxic substances which can be leached out of PVC tubing by infused solutions have been shown by Duke and Vane (1968) to affect the normal response of the perfused human umbilical artery to stimuli, and by Bowery and Lewis (1968) to cause contraction of the isolated guinea-pig ileum; the effect on the portal vasculature of these substances and of a 10% solution of dextrose, which has a pH of 5 * 6 or less and is irritant, might explain the transient obstruction of 5 infants in this series.…”

Section: Discussionmentioning

confidence: 71%

Functional Intestinal Obstruction in the Neonate

Howat¹,

Wilkinson²

1970

Archives of Disease in Childhood

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Section: Discussionmentioning

confidence: 71%

Functional Intestinal Obstruction in the Neonate

Howat¹,

Wilkinson²

1970

Archives of Disease in Childhood

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“…The onset is earlier and more rapid than in preterm infants and predisposing disorders affecting the circulation are usually present. NEC in term infants has been linked to congenital heart disease and/or heart operation [48,49] , perinatal asphyxia, polycythemia [50] , exchange transfusion [51][52][53][54] , protracted diarrhea with dehydration, maternal cocaine abuse, and exposure to HIV or antiretroviral medication.…”

Section: Related Disorders and Differential Diagnosismentioning

confidence: 99%

Necrotizing Enterocolitis – 150 Years of Fruitless Search for the Cause

Obladen¹

2009

Neonatology

126

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Necrotizing enterocolitis (NEC) is not a new disease but one that has been reported since special care units began to house preterm infants. It was observed in foundling hospitals in Paris [Billard, 1828] and Vienna [Bednar, 1850] and, as it occurred in clusters, was regarded as a nosocomial infection in the infant hospitals of Zurich [Willi, 1944] and Berlin [Ylppö, 1931]. Clinical and patho-anatomic characterization was achieved by Schmidt and Quaiser in 1952. The unproven hypothesis of mesenteric hypoperfusion as a major etiological factor arose from animal models and analogous perforating disorders in term infants. Despite similarities between NEC and clostridial infections, few studies employed anaerobic culture techniques. The pathogenesis remains unclear and its distinction from related disorders uncertain. It is unlikely that strategies to prevent NEC will be successful unless the disease is better understood.

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“…We have previously demonstrated in an experimental model that transient portal hypertension may result from closure of the DV shortly after birth resulting in intestinal injury [5], which led us to initiate a clinical study to examine the potential role of DV occlusion in the development of NEC in premature infants. The effects of the UVC on portal blood flow and its relationship to NEC have never previously been investigated despite multiple assertions that ischemia plays a role in NEC [16,17]. Unfortunately, direct measurements of portal pressure in premature infants are impossible to obtain without the insertion of an invasive monitoring device, which was not done in this study.…”

Section: Discussionmentioning

confidence: 71%

Umbilical Venous Catheter Malposition Is Associated with Necrotizing Enterocolitis in Premature Infants

Sulemanji

Vakili²,

Zurakowski³

et al. 2017

Neonatology

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Objective: The etiology of necrotizing enterocolitis (NEC) remains elusive despite known associations with several factors, including intestinal ischemia related to the effects of umbilical arterial catheterization on the mesenteric circulation. However, the role of the mesenteric venous circulation has yet to be studied as a potential cause of NEC. We examined the association between umbilical venous catheter (UVC) position and the development of NEC in premature infants. Design: A prospective cohort study was performed to examine the effect of UVC on portosystemic shunting via the ductus venosus (DV) and its potential role in NEC. Results: We recruited 132 premature infants, 62 of which had a birth weight ≤1,500 g. NEC was noted in 12 (19%) patients. All infants weighing ≤1,500 g underwent an attempt at UVC insertion. The UVC status was classified as appropriate (n = 39), unsuccessful (n = 9), or malpositioned (n = 14). Among the NEC patients, 7 (58%) had a UVC malposition and 3 (25%) had an unsuccessful attempt. These rates were significantly higher than in patients without NEC (14 and 12%, respectively). Multivariable logistic regression analysis confirmed birth weight (OR 2.2, 95% CI 1.2-4.7, p = 0.001) and UVC malpositioning (OR 6.9, 95% CI 1.6-35.4, p = 0.007) as independent risk factors associated with NEC. Conclusions: Unrecognized withdrawal of a UVC into the portal vein or DV is associated with an increased incidence of NEC in infants weighing ≤1,500 g. The data support the need for additional studies to examine this effect. Confirmation of a causal relationship will raise the need to reassess UVC insertion criteria and strategies for more closely monitoring the catheter tip position.

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Colonic Perforation after Exchange Transfusion

Cited by 70 publications

References 10 publications

Functional Intestinal Obstruction in the Neonate

Functional Intestinal Obstruction in the Neonate

Necrotizing Enterocolitis – 150 Years of Fruitless Search for the Cause

Umbilical Venous Catheter Malposition Is Associated with Necrotizing Enterocolitis in Premature Infants

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