OC58 Morbidity and mortality of medical and surgical necrotising enterocolitis

Abstract

guidelines (www.nhlbi.nih.gov/health-pro/guidelines/current/von-willebrandguidelines/full-report/4-management-of-vwd.htm) in which the suggested level for the designation of type 1 VWD was a VWF:Ag or VWF:RCo level of <30 IU/dL and 'low VWF levels' refer to individuals with VWF:Ag levels between 30 and 50 IU/dL. The aim was to reclassify the VWD patient cohort at the National Paediatric Comprehensive Care Centre Our Lady's Children's Hospital Crumlin, Dublin. Methods 315 Case records of children <18 years with VWD or possible VWD over a 10 year period were retrospectively extracted from the Irish National Bleeding Disorder database. These records were 'interpreted' according to NHLBI/NIH diagnostic criteria. The algorithm applied was; VWF level-s<30IU/dl on 2 separate occasions-VWD; VWF levels 30-50IU/dl on 2 separate occasions-Low VWF; VWF not less than 50IU/dl on 2 occasions and multiple testing-not VWD. Blood group was also recorded. Where incomplete laboratory data, patients were recalled to a review clinic for further testing.Results 315 children on the Irish National Bleeding disorder database had been historically diagnosed with VWD or possible VWD.Following the review there was a 81% reduction in the number of patients diagnosed with Type 1 VWD (187 patients in the original cohort were classified as Type 1 which reduced to 36 post -reclassification).Predictably, no significant change in numbers diagnosed with Type 2 (26) and Type 3 (2 patients) VWD, 185 (59% of total population) are now classified as Low VWF with a preponderance of Group O patients. 37 (15% of total population) were deemed to have no form of VWD and reclassified as normal.19 (6% of total population) have not returned for full reclassification and still remain as unspecified or possible. Discussion/Conclusion Our data suggest over-diagnosis of VWD in this population using previous guidelines. Diagnosis, especially for individuals with mildly decreased VWF (30-50IU/dl) requires correlation of clinical assessment and laboratory results. Reclassification has resulted in reallocation of resources to priority patients.This recommendation does not preclude the diagnosis of VWD in individuals with VWF:RCo of 30-50 IU/dl if there is supporting clinical and/or family evidence for VWD or the use of agents to increase VWF levels where VWF:RCo is 30-50IU/dl and may be at risk for bleeding.

Association between prognostic factors and the clinical deterioration of preterm neonates with necrotizing enterocolitis

“…Necrotizing enterocolitis (NEC) is a severe gastrointestinal emergency that affects preterm neonates 1 , 2 . NEC is responsible for most perioperative fatalities in pediatric surgery, with a mortality rate of up to 19% 3 .…”

C-reactive protein/albumin ratio is a prognostic indicator for predicting surgical intervention and mortality in neonates with necrotizing enterocolitis

“…Necrotizing enterocolitis (NEC) is one of the most common and critical gastrointestinal emergencies in neonates, which predominately affects premature and low birth weight infants in the first weeks of life. Surgical NEC is known to be associated with a significantly higher morbidity and mortality [ 1 , 2 ]. However, the optimal timing for surgical intervention in neonates with NEC is not yet established [ 3 , 4 ].…”