Change in treatment policy for neonatal gastrointestinal perforations
Abstract
The outcomes of treatment for neonatal perforative peritonitis during 20 years (1992 to 2011) were studied. A total of 31 newborn infants with peritonitis were treated at the surgery department (neonates with complications of intestinal malformations were excluded). The newborn infants with Stage III necrotizing enterocolitis (n=13) and spontaneous gastric perforations (n=13) constituted 84%. Since 2002 we have been applying peritoneal drainage in the package of measures for preoperative patient preparation to decompress the abdominal cavity, which could lengthen the preparation time from 1,5—2 to 8—12 hours. In this case, there was a possibility of more adequately correcting fluid and electrolyte metabolic disorders, restoring urine output, relieving the signs of infectious and toxic shock, and preventing the complications of general peritonitis, such as multiple organ dysfunction and disseminated intravascular coagulation. Over the study period, the mortality among the newborn infants with perforative peritonitis decreased from 75 to 21%.
About the Authors
V. A. Savvina
Medical Institute, M.K. Ammosov North-Eastern Federal University, Yakutsk; Pediatric Centre, Republican Hospital One, National Centre of Medicine, Yakutsk
Russian Federation
Russian Federation
A. R. Varfolomeyev
Medical Institute, M.K. Ammosov North-Eastern Federal University, Yakutsk
Russian Federation
Russian Federation
V. N. Nikolayev
Pediatric Centre, Republican Hospital One, National Centre of Medicine, Yakutsk
Russian Federation
Russian Federation
A. Yu. Tarasov
Pediatric Centre, Republican Hospital One, National Centre of Medicine, Yakutsk
Russian Federation
Russian Federation
References
1. Красовская Т.В. Оптимизация диагностических и лечебных программ в хирургии новорожденных: Автореф. дис. … д-ра мед. наук. М 1991; 48. (Krasovskaya T.V. Optimization of diagnostic and medical programs in surgery of newborns: Avtoreferat Dis. …d-ra med. nauk. M 1991; 48.)
2. Rees C.M., Eaton S., Pierro A. National prospective surveillance study of necrotizing enterocolitis in neonatal intensive care units. J Pediat Surg 2010; 45: 7: 1391—1397.
3. Downard C.D., Grant S.N., Mathenson P.J. et al. Altered intestinal microcirculation is the critical event in the development of necrotizing enterocolitis. J Pediat Surg 2011; 46: 6: 1023—1028.
4. Караваева С.А. Хирургическое лечение некротического энтероколита: Автореф. дис. … д-ра мед. наук. Ст-Петербург 2002; 47. (Karavayeva S.A. Surgical treatment necrotizing enterocolitis: Avtoreferat Dis. … d-ra med. nauk. St-Peterburg 2002; 47.)
5. Подкаменев В.В., Новожилов В.А., Тимофеев Д.В. и др. Лечение перфораций желудочно-кишечного тракта у новорожденных. Дет хир 2007; 2: 4—6. (Podkamenev V.V., Novozhilov V.A., Timofeev D.V. et al. Treatment of perforation of a gasrtointestinal path at newborns. Det Khir 2007; 2: 4—6.)
6. Писклаков А.В., Федоров Д.А., Новиков Б.М. Опыт лечения новорожденных с некротизирующим энтероколитом с учетом показателей внутрибрюшного давления. Дет хир 2012; 2: 27—29. (Pisklakov A.V., Fedorov D.A., Novikov B.M. Experience of treatment of newborns with necrotizing enterocolitis taking into account indicators of intraperitoneal pressure. Det Khir 2012; 2: 27—29.)
7. Zornoza M., Pelaez D., Romero R. et al. Role of peritoneal drainage in necrotizing enterocolitis in critical infants with extremely low birth weight. Cir Pediat 2011; 24: 3: 146—150.
Review
For citations:
Savvina V.A., Varfolomeyev A.R., Nikolayev V.N., Tarasov A.Yu. Change in treatment policy for neonatal gastrointestinal perforations. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics). 2014;59(1):93-97. (In Russ.)
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