112
~o}!ij3l}: :111 7 i! fil1 2 ~ 2001';1 Vol. 7, No, 2, December 2001
Intestinal Perforations in Very Low Birth Weight Infants
Dae Yeon Kim, M.D., Seong Chul Kim, M.D., Ai-Rhan Kim*, M.D., Ki Soo Kim*, M.D., Soo Young Pi*, M.D., In Koo Kim, M.D.
Department of Surgery and Pediatrics*, Asan Medical Center, University of Ulsan College of Medicine Seoul, Korea
With the advances in neonatal intensive care, pediatric surgeons experience very low birth weight infants, weighing (1,500 g, more frequently. We report our 14 cases of very low birth weight infants with intestinal perforations without congenital causes, at the Asan Medical Center during the ll-year period from 1989 to 2000. The average birth weight was 919 g(563-1,490), and average gestational age was 206 days061-286)' There were nine males and five females , Operation was performed at an average age of 14.0 days(3-38). Ten neonates with symptomatic PDA were given indomethacin in an attempt to close the ductus. Bowel perforation involved the jejunum in two and ileum in twelve. At laparotomy, there were seven focal intestinal perforations, five typical NEC, one intussusception, and an unknown cause, Four neonates underwent resection and anastomosis of the bowel, and nine underwent exteriorization. One underwent resection and anastomosis after peritoneal drainage. Four patients had postoperative complications; two leakage of anastomosis, one stoma necrosis , and one internal herniation. Seven of fourteen patients survived(50.0 %). Seven patients died of septic complication. There was a significant difference in the birth weight and gestational age in survivors compared with those who died(p(0.05). There was an increased risk of bowel perforation in indomethacin treatment for PDA. Careful clinical observation and keen judgment are essential for this particular group of infants.
(J
Kor
AssocPediatr
Surg 7(2):112-117), 2001.Index Words: Very low birth weif!ht infants, Intestinal perforation
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Table 1. Summary of Cases
Case GA(wk) BW(kg) Age at Op (ds) . PDAllndo Lesion Cause Operation Outcome/Complication
Extremely Vel}' Low Birth Weight Infant «7S0g)
23 563 26 +/+ Ileum NEC, standard Ileostomy Died at POD#3
2 25 645 20 +/+ Ileum Focal perforation Ileostomy Survive/Stoma necrosis
3 24 684 3 +/+ Ileum Focal perforation Ileostomy Died at POD#2
4 24 730 7 +/+ Ileum Focal perforation Ileostomy Died at POD#1
Extremely Vel}' Low Birth Weight Infant (7S0-1000g)
rr
05 24 783 16/25 +/+ Jejunum Unknown PO/ R & A Died at POD#30 ~
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6 25 798 10 +/+ Ileum Focal perforation Ileostomy Survive 11!.
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7 29 831 7 +/+ Ileum Focal perforation Ileostomy Died at POD#7
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9 28 967 6 +/+ Jejunum Focal perforation R&A Died at POD#65/Leakage 0
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10 28 992 3 +/+ Ileum Focal perforation R&A Survivellnternal herniation
Vel}' Low Birth Weight Infant(1000-1,SOOg)
11 29 1150 12 +/+ Ileum NEC, standard Ileostomy Survive
12 27 1185 25 -/- Ileum Intussusception R&A Survive/Leakage
13 32 1212 38 -/- Ileum NEC, standard Ileostomy Survive
14 30 1490 11 +/- Ileum NEC, standard R&A Survive
Abbrevation: GA; gestational age, BW; birth weight, PDA; patent ductus arteriosus, Indo; indomethacin, PO; peritoneal drainage, R & A; resection and anastomosis
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