Managing neonatal bowel obstruction: clinical perspectives

Desoky, Sarah M.; Kylat, Ranjit I; Udayasankar, Unni K.; Gilbertson-Dahdal, Dorothy

doi:10.2147/rrn.s125760

Cited by 7 publications

(7 citation statements)

References 36 publications

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“…bilious vomiting, abdominal distension, failure to pass m e c o n i u m , i m p e r f o r a t e a n u s ) , p r i m a r y management and early referral to paediatric surgical centres may further reduce mortality from neonatal intestinal obstruction in developing world like ours. 1,3,10,[19][20][21] Our study provides a valid representation of pattern and outcome nationwide. There is a need for more studies in depth on this topic of neonatal intestinal obstruction.…”

Section: Discussionmentioning

confidence: 99%

Patterns and Outcome of Neonatal Intestinal Obstruction in Kanti Children’s Hospital

Thapa

Basnet

2020

J. Nepal Paedtr. Soc.

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Introduction: Neonatal intestinal obstruction is the most common neonatal surgical emergency. More than 75% of neonatal surgeries are done for the correction of this problem. The outcome of this obstruction mainly depends upon the causes of obstruction, clinical condition of the patient, associated anomalies, expertise and centre where the patient is dealt. This study was undertaken to study the clinical features and outcome of neonatal intestinal obstruction presented in our centre. Methods: The medical records of all neonates admitted in the surgical NICU were selected and cases with the diagnosis of neonatal intestinal obstruction and managed surgically during two years period from September 1, 2015 to September 1, 2017 were retrospectively reviewed and analysed in regard to age at presentation, sex, weight, gestation, postoperative diagnosis and their outcome. Results: Out of 235 admitted neonates, 205 cases were treated surgically for intestinal obstruction. There were a total of 154 (75.2%) males and 51 (24.8%) females. Mean age at presentation was 4.5 days and average weight was 2.25 kg. Among them, anorectal malformation (ARM) 88 (42.92%), intestinal atresia 59 (28.78%), Hirschsprung’s disease 38 (18.53%), malrotation of gut 10 (4.87%) and meconium ileus 10 (4.87%) were the etiology. Among intestinal atresia, duodenal atresia 27 (45.76%) was the commonest one followed by ileal atresia 24 (40.67%), six jejunal atresia (10.16%) and two colonic atresia (3.38%). Overall, 160 neonates survived (78.04%). Among the survival, Hirschsprung’s disease was 34 (89.47%), ARM 78 (88.63%), seven malrotation of gut (70%), six meconium ileus (60%) and intestinal atresia 35 (59.32%). Conclusion: Neonatal intestinal obstruction is the most common neonatal surgical emergency in Kanti Children’s Hospital. Anorectal malformation was the commonest etiology followed by intestinal atresia and Hirschsprung’s disease. Overall survival rate was 78%. Cases with Hirschsprung’s disease and anorectal malformation had about 90% survival rate. Intestinal atresia was the major cause of mortality occupying 53.35% of total mortality of 21.95%. Mortality is mainly due to delayed diagnosis, referral and intervention which lead to higher complications of cases.

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Section: Discussionmentioning

confidence: 99%

Patterns and Outcome of Neonatal Intestinal Obstruction in Kanti Children’s Hospital

Thapa

Basnet

2020

J. Nepal Paedtr. Soc.

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“…5,6 The diagnosis may be suspected before delivery due to prenatal ultrasound findings, including polyhydramnios or fetal double-bubble sign in duodenal atresia. 7 The pathological course of intestinal obstruction in newborns progresses rapidly and is poorly tolerated by most of them, but timely diagnosis and treatment lead to a better outcome. 8,9 Most cases of intestinal obstruction in the neonatal period require surgical intervention, which is a challenging issue for this age especially in developing countries 6,10,11 Neonates usually require surgical management by trained pediatric surgeons in tertiary care neonatal intensive care units.…”

Section: Introductionmentioning

confidence: 99%

“… 5 , 6 The diagnosis may be suspected before delivery due to prenatal ultrasound findings, including polyhydramnios or fetal double-bubble sign in duodenal atresia. 7 …”

Section: Introductionmentioning

confidence: 99%

Etiology and Outcome of Intestinal Obstruction in Neonates: A 5-Year Investigation of Admitted Cases From a Tertiary Neonatal Intensive Care Unit in Northern Iran

Farrokhkhani,

Farhadi,

Ala

et al. 2023

Clin Med Insights Pediatr

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Background: Neonatal intestinal obstruction is a challenging issue, especially in developing countries. There is an apparent difference in the etiology, complications, and mortality of intestinal obstruction in neonates in different countries. Objectives: We aimed to describe the causes, early postoperative outcomes, and predictors of morbidities in neonates with intestinal obstruction in a tertiary neonatal intensive care unit (NICU) in Iran. Design & methods: We conducted a retrospective study on neonates who were admitted with intestinal obstruction requiring surgery in the NICU of Boo-Ali Sina Hospital in northern Iran during 2018 to 2022. Demographic and clinical characteristics of the newborns, final diagnosis, postoperative complications, and mortality rate were documented. Also, the relationship between postoperative complications and risk factors, including birth weight, gestational age, and surgical intervention time, was evaluated. Results: A total of 169 neonates with intestinal obstruction requiring surgery were admitted with a male ratio of 60.9% and mean age of 3.85 ± 8.01 days. Imperforate anus with a prevalence of 42% was the most common cause of neonatal intestinal obstruction, followed by Hirschsprung’s disease and duodenal atresia. Death after surgery occurred in 4.1% of the patients. Sepsis with a prevalence of 1.4% was the most common early postoperative complication. The late surgical intervention had a statistically significant relationship with the increase in postoperative sepsis ( P = .048). Conclusion: The time of surgical intervention is the main predictor of complications in neonatal intestinal obstruction, so prompt diagnosis and timely treatment of these babies can significantly improve the prognosis. It is also necessary to improve access to pediatric surgery services in developing countries.

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“…1, 2 Among the bowel atresias, jejunoileal atresias (JIA) are described as the most common variety, with an incidence of 1 in 1,500 live births followed by duodenal atresias (DA); 1:5,000 to 1:10,000 live births. 3-5 Pyloric atresias (PA) and colonic atresias (CA) are rare anomalies with incidences of 1:100,000 and 1:66,000 live births, respectively. 6-8 The embryological disorder behind the atresias, affecting different parts of bowel, is also different.…”

Section: Introductionmentioning

confidence: 99%

Demographic Pattern, Management, and Outcome of Intestinal Atresias Among Neonates in a Tertiary Care Indian Hospital

Tripathy

Jena

2021

Journal of Neonatology

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Objectives: To analyze the incidence, management approach, and outcome of intestinal atresias among neonates in our hospital. Design: Retrospective observational study. Settings: Tertiary care pediatric institute located in eastern part of India. Study period: January 2015 to December 2019. Results: Intestinal atresias constituted 54% of neonatal intestinal obstruction cases ( n = 369). Out of 201 cases of intestinal atresias, only 120 patients presented during first week of life and the male to female ratio was 1.3:1. The mean (±SD) weight at presentation was 2.03 (±0.49) kg and newborns below 1.5 kg were associated with significantly higher mortality ( P =.001). Jejunoileal atresias were found to be the most common type of atresia ( n = 116, 58%) followed by duodenal atresias ( n = 67, 33%). Colonic and pyloric atresias were found in 14 (7%) and 4 cases (2%), respectively. The overall mortality in the present study was 18% ( n = 36) and septicemia was the leading cause. Conclusion: Intestinal atresias were the most common cause of intestinal obstruction and surgical emergency in neonates. Although, there is gradual improvement in survival in these newborns, low birth weight, late presentation, and associated comorbidities are high risk factors. Increased awareness about these congenital anomalies, early referral to tertiary care centers, and timely management can improve the outcome.

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Managing neonatal bowel obstruction: clinical perspectives

Cited by 7 publications

References 36 publications

Patterns and Outcome of Neonatal Intestinal Obstruction in Kanti Children’s Hospital

Patterns and Outcome of Neonatal Intestinal Obstruction in Kanti Children’s Hospital

Etiology and Outcome of Intestinal Obstruction in Neonates: A 5-Year Investigation of Admitted Cases From a Tertiary Neonatal Intensive Care Unit in Northern Iran

Demographic Pattern, Management, and Outcome of Intestinal Atresias Among Neonates in a Tertiary Care Indian Hospital

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