Predictive Factors for Postoperative Outcome in Children with Jejunoileal Atresia

Jarkman, Charlotta; Salö, Martin

doi:10.1055/s-0039-1697628

Cited by 8 publications

(17 citation statements)

References 16 publications

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“…Surgery for JIA in Germany reveals an obvious concept of performing primary ostomy in most patients (59.8%). This finding is clearly different from the literature where the rate is between 11 and 42% (17,25,(27)(28)(29). One reason for the higher rate of stoma formation could be seen in the number of patients with NEC who determine 10% of the analyzed patients.…”

Section: Discussioncontrasting

confidence: 88%

“…The LOS of our patients was greater than that in other studies. International studies show a median LOS between 16 and 32 days (16,17,25) or an average LOS of 41 days (2). In contrast, we had a median LOS of 66 days.…”

Section: Discussioncontrasting

confidence: 67%

“…The male:female ratio of 1.2 is in the range of other studies (18,22,23). The rate of premature children (64.4% in all patients, and in 61.1% in the group without NEC) was greater than that in other studies, where it was reported to be between 34 and 55% (17,20,24,25). This finding could be related to the abovementioned inclusion criteria given that patients with abdominal wall defects tend to be born prematurely.…”

Section: Discussionmentioning

confidence: 56%

“…This retrospective observational study shows the epidemiology and outcome parameters of 435 children with JIA over a 10-year period. In contrast to other studies (17,18), concomitant diseases, such as abdominal wall defects or volvulus, were deliberately included in the analysis. The use of administrative claims data includes the risk of a coding error.…”

Section: Discussionmentioning

confidence: 99%

“…This finding could be related to the abovementioned inclusion criteria given that patients with abdominal wall defects tend to be born prematurely. Another reason can be seen in the fact that some studies provide study populations which start in the 70th of last century (17,24) where the rate of pre-mature children treated was lower than today. One study from South Africa that focused on apple peel atresia reported an even higher rate of premature children (82.4%) (26).…”

Section: Discussionmentioning

confidence: 99%

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Jejunoileal Atresia: A National Cohort Study

et al. 2021

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Purpose: Jejunoileal atresia (JIA) is a rare disease. We aimed to determine the overall incidence of this malformation and associated malformations in a national cohort. Furthermore, we compared the treatment results of this cohort with the current literature.Methods: Data from the major health insurance company, which covers ~30% of the German population, were analyzed. All patients with ICD-10-Code Q41.1-9 (atresia of jejunum, ileum, other parts and not designated parts of the small bowel) who underwent any surgical procedure for small bowel were analyzed in a 10-year period between 2007 and 2016.Results: A total of 435 patients were included in the study. The incidence was 2.1 per 10,000 live births. The male:female ratio was 1:2. Sixty-four percent were premature, 21% had associated cardiac anomalies, 16% had abdominal wall defects, 7% had urogenital malformations, and 7% had cystic fibrosis. Sixty percent of all patients with jejunoileal atresia, 57% of patients with accompanying abdominal wall defects and 72% of patients with associated cystic fibrosis required ostomy as the initial procedure. In 25% of all patients, only one intestinal operation was coded. In 39% of patients, two operations were coded. Twelve percent of all patients required feeding gastrostomy or jejunostomy. Sixteen percent of all patients presented with liver-related complications, i.e., cholestasis or liver insufficiency. Six patients underwent an intestinal lengthening procedure (2 Bianchi, 4 STEP). In five patients, initial lengthening was performed within 1 year after the first intestinal operation. Mortality until 1 year after initial surgery was 5%. Of those who died, 88% were premature, 34% had cardiac anomalies and 16% had abdominal wall defects. None had cystic fibrosis. Patients with ostomy significantly more often needed operative central venous line or operative feeding tube. Short bowel was coded significantly more often in these patients.Conclusion: Patients with JIA present with low mortality. The rate of ostomies is higher than in literature. To give clinical recommendations for the initial surgical approach, further clinical research is needed.

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Section: Discussioncontrasting

confidence: 88%

Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Jejunoileal Atresia: A National Cohort Study

et al. 2021

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Type 3B jejunoileal atresia management at a tertiary hospital in northern Tanzania: A report of three cases

Rwomurushaka,

Msuya,

Mbwambo

et al. 2024

Clinical Case Reports

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Key Clinical MessageJejunalileal atresia is a cause of intestinal obstruction in the newborn, hence a surgical emergency. Prenatal diagnosis can be made by simple obstetric ultrasound and postnatal by plain abdominal x‐ray to plan a multidisciplinary approach to reduce morbidity and neonatal mortality.AbstractAtresia can occur anywhere along the intestines and is a common cause of intestinal obstruction in neonates. Jejunoileal atresia (JIA) is a rare disease occurring in 2.1 per 10,000 live births. Type 3b jejunoileal atresia occurs in 11% of all small bowel atresia. We present three cases of type 3b jejunoileal atresia. They were all missed by prenatal ultrasonography, and presented with features of intestinal obstruction. The diagnosis was confirmed by plain abdominal x‐rays and ultrasound, followed by laparotomy. Postoperative care was given in the neonatal unit according to local protocols. One recovered, however, two succumbed from neonatal infection. Jejunoileal atresia requires surgery and long postoperative care, with outcomes associated with numerous prognostic factors including multidisciplinary care and neonatal intensive care. Jejunoileal atresia is less commonly associated with other congenital anomalies, unlike duodenal atresia. Efforts are needed to scale up prenatal diagnosis of jejunoileal atresia, and therefore to plan for appropriate care after delivery. Also, further studies are needed to understand neonatal sepsis in the postoperative period and ways to improve outcomes.

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Central Venous Catheter Associated Bloodstream Infections and Thrombosis in Patients Treated for Gastroschisis and Intestinal Atresia: a Retrospective Cohort Study of 238 Patients

Schattenkerk

Musters

Otterloo

et al. 2022

Preprint

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Background: Central venous catheter related complications, mainly central line associated bloodstream infections (CLABSI) and thrombosis, can complicate treatment of intestinal atresia or gastroschisis. Incidences and risk factors, e.g., location (central versus peripheral inserted) or mode of insertion (tunnelled versus non-tunnelled), of these complications are widely unknown. Therefore, we aim to identify the incidence of and risk factors for CLABSI and thrombosis in these patients.Methods: Children treated for intestinal atresia or gastroschisis between 1998-2021 at our tertiary referral center were retrospectively included. Risk factors for CLABSI were identified using logistic regression and the correlation between thrombosis and location/mode of insertion was evaluated using chi2-tests.Results: In 238 patients, 35% developed CLABSI and 7% thrombosis. Treatment by enterostomy (OR:3.1;95%-CI:1.5–6.4) and non-tunnelled catheters (OR:2.0;95%-CI:1.3–4.6) significantly increased the CLABSI-risk whilst patient’s sex, catheter placement directly into central vein, preterm birth, trisomy 21, experiencing a major postoperative complication (Clavien-Dindo grade ≥III) and birthweight didn’t. Catheter dwell time was shorter (p<0.01) and CLABSIs developed faster (p=0.02) in non-tunnelled compared to tunnelled catheters. Catheter related thrombosis occurred more often in non-tunnelled catheters (p=0.03), whilst no correlation (p=0.34) was found between location of insertion.Conclusion: CLABSI occurs in approximately one third of the children treated for intestinal atresia or gastroschisis and a catheter related thrombosis occurs in one in fourteen. When in doubt which catheter to use in these patients, a tunnelled catheter is preferred over a non-tunnelled, specifically in case of enterostomy formation, since a tunnelled catheter is comparatively less at risk of catheter related infections and thrombosis.

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Predictive Factors for Postoperative Outcome in Children with Jejunoileal Atresia

Cited by 8 publications

References 16 publications

Jejunoileal Atresia: A National Cohort Study

Jejunoileal Atresia: A National Cohort Study

Type 3B jejunoileal atresia management at a tertiary hospital in northern Tanzania: A report of three cases

Central Venous Catheter Associated Bloodstream Infections and Thrombosis in Patients Treated for Gastroschisis and Intestinal Atresia: a Retrospective Cohort Study of 238 Patients

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