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Query: UMLS:C0728731 (prematurity)
 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-seven patients with gastroschisis were seen at the Red Cross War Memorial Children's Hospital between 1960 and 1977. Twenty-five children were operated on either by primary closure, by skin closure alone, or by the insertion of a reinforced Silastic pouch or patch. The mortality rate has been reduced from 62% to 33% over the past 6 years. Despite better metabolic and respiratory care and intravenous alimentation, serious complications still occur, particularly when prematurity and associated anomalies such as atresia or meconium ileus exist. Other problems were respiratory complications, ileus, perforation, gangrene, intestinal obstruction, enterocolitis and disaccharide intolerance. The long-term follow-up of some of these patients is described.
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PMID:Complications and follow-up of gastroschisis. 15 4

In intestinal anomalies, preventive surgical procedures include gastrostomies and enterostomies as well as some special operations such as ligature of the cardia and associated appendectomies. General indications for enterostomies are seen in life-threatening circumstances, i.e. prematurity, surfactant deficiency, major associated malformations and complications. Preventive surgical procedures are necessary in certain cases of esophageal atresia, complicated small bowel atresia, meconium ileus, anorectal malformations, Hirschsprung disease, neuronal intestinal dysplasia and necrotizing enterocolitis. Prophylactic surgery requires detailed knowledge of the definitive therapeutic procedure.
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PMID:[Preventive operations in intestinal abnormalities]. 179 5

Primary tissue closure of gastroschisis remains controversial. Some surgeons routinely place a silicone rubber sheet silo over the exposed bowel, planning a staged closure. In the past 14 1/2 years, we have cared for 106 newborns with gastroschisis, closing the defect primarily in 80%. The success of this technique depends on enlarging the abdominal cavity and decreasing the volume of bowel that must be replaced in the peritoneal cavity. Thorough preoperative rectal irrigation should evacuate all meconium. After undermining the skin around the abdominal wall defect for only 1 cm, a midline subcutaneous fasciotomy is created from the xiphoid to the pubis. The abdominal wall is then stretched in all quadrants beginning at the flanks. The eviscerated small bowel can often be returned without enlarging the initial skin defect. The skin is closed with subcuticular absorbable sutures reinforced by long skin tapes. The small ventral hernia that results is closed at about 1 year of age. Fascia could be closed primarily in 28% of these patients, and 17% required a prosthetic pouch. The duration of postoperative ileus and length of hospital stay were statistically significantly shorter in the infants who underwent primary closure. Even though more complicated patients were included in the primary closure group, the incidence of mortality and morbidity was not higher than in patients treated with silicone rubber pouches. Deaths were inevitable in five infants with gangrenous bowel, multiple anomalies, and extreme prematurity. Deaths were related to sepsis in three infants and were the result of operative or anesthetic technique in four. Only two preoperative factors were prognostic of morbidity and mortality: gestational age (but not birth weight) and the presence of intestinal ischemia or atresia.
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PMID:Gastroschisis in 106 consecutive newborn infants. 293 43

The pathogenesis of neonatal necrotizing enterocolitis is still unknown today. Only prematurity has been confirmed as a primary risk factor. Previous studies demonstrated the special pathophysiological conditions in prematurity. Differences in intestinal permeability, blood flow in anemia and hypoxemia, the uptake, transport, delivery and consumption of oxygen, the digestion of carbohydrates and proteins and in intestinal motility between premature and term infants exist. The diving-reflex too is important for intestinal pathophysiology in these patients. The central key of the pathogenesis is the evident vascular damage. Infectious agents, inflammatory mediators, circulatory insufficiency, feeding excess is followed by the initial mucosal damage. This results in an increased intestinal permeability also for inflammatory mediators, endotoxins, bacteria and gas. Ileus, stasis and gas production cause endotoxinemia and abdominal distension. Increased intraluminal pressure with or without activation of inflammatory mediators leads to an important vascular dysregulation. Consecutively these multiple facts cause the "ischemic looking" hemorrhagic necrosis, we call necrotizing enterocolitis.
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PMID:[Pathogenetic concepts of neonatal necrotizing enterocolitis]. 769 26

In this retrospective study carried out covering the period, 1978-1991, 62 neonates were seen, diagnosed and treated for intestinal atresia which included: duodenal atresia and stenosis, small bowel atresia and atresia of large bowel. Locations of obstruction were duodenal in 17 patients, jejunal in 25 patients, jejuno-ileal in 5 and colon in two. Duodenal atresia was noted in 9 infants and duodenal stenosis due to annular pancreas, Ladd's bands with malrotation of bowel in 8. Associated anomalies which were observed were anorectal malformations in 2 and malrotation in 2 infants. Birth weights ranged from 1450 gm to 3000 gm. Prematurity was recorded in 11 infants. Diagnosis of intestinal atresia in our patients was made clinically and radiologically. Intestinal atresia in neonates was differentiated from other causes of obstruction such as Meconium Ileus, Hirschsprung's disease, neonatal volvulus, rectal atresia in anorectal malformations. Treatment of infants with intestinal atresia was surgical. Surgical techniques used depended on pathological findings. In 36 patients, complications such as functional obstructions with vomiting and failure to thrive, malabsorption, aspiration, bronchopneumonia, sepsis were observed. Overall mortality rate in our cases was 25 (41.9%) out of 62 patients.
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PMID:Intestinal atresia and stenosis as seen and treated at Kenyatta National Hospital, Nairobi. 818 36

Any newborn who continues to vomit in the first few days of life, particularly if the vomitus contains bile and if the abdomen is distended, should have immediate investigation because intestinal obstruction in the newborn is a fatal condition unless promptly recognized and surgically corrected. The most common cause of obstruction at this age is atresia and the simplest possible surgical procedure which adequately corrects this deformity should be done. It is also possible to successfully correct the obstruction caused by other congenital deformities such as annular pancreas and meconium ileus. Although prematurity is a definite factor in the outcome, intestinal obstruction in the newborn can be corrected with a surprisingly low mortality. Occasionally unusual methods are needed to tide these infants over the critical period of postoperative care.
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PMID:Intestinal obstruction in the newborn. 1330 85

Postnatal growth restriction and failure to thrive have been recently identified as a major issue in preterm, especially extremely-low-birth-weight neonates. An increased length of time to reach full enteral feedings is also significantly associated with a poorer mental outcome in preterm neonates at 24 months corrected age. Optimization of enteral nutrition without increasing the risk of necrotizing enterocolitis (NEC) has thus become a priority in preterm neonates. A range of feeding strategies currently exists for preventing/minimizing feed intolerance in preterm neonates reflecting the dilemma surrounding the definition and significance of signs of feed intolerance due to ileus of prematurity and the fear of NEC. The results of a systematic review of current strategies for preventing/minimizing feed intolerance in preterm neonates are discussed. The need for clinical research in the area of signs of feed intolerance is emphasized to develop a scientific basis to feeding strategies. Only large pragmatic trials based on such strategies will reveal whether the benefits (improved growth and long term neurodevelopmental outcomes) of aggressive enteral nutrition can outweigh the risks of a potentially devastating illness like NEC, and of prolonged parenteral nutrition in preterm neonates.
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PMID:Strategies for prevention of feed intolerance in preterm neonates: a systematic review. 1610 95

Prevention and treatment of NEC has become an area of priority for research due to the increasing number of preterm survivors at risk, and the significant mortality and morbidity related to the illness. Probiotic supplementation appears to be a promising option for primary prevention of NEC but further large trials are necessary for documenting their safety in terms of sepsis as well as long-term neurodevelopmental outcomes and immune function. As new frontiers including immunomodulating agents like pentoxifylline continue to be explored, the impact of well-established simple strategies like antenatal glucocorticoid therapy, and early and preferential use of breast milk must not be forgotten. Clinical research on manifestations of ileus of prematurity, and feeding in the presence of common risk factors such as IUGR is needed. Safety of minimal enteral feeds in terms of NEC and benefits of standardised feeding regimens need to be confirmed. Association of common clinical practices such as red cell transfusions, H2 receptor blockade, and thickening of feeds with NEC warrants attention. An approach utilising a package of potentially better practices seems to be the most appropriate strategy for the prevention and treatment of NEC.
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PMID:Prevention and treatment of necrotising enterocolitis in preterm neonates. 1782 9

Aim: To evaluate the results of the use of the T-tube ileostomy in neonatal intestinal surgery cases. Materials and Methods: A retrospective review of sixty two neonates underwent intestinal obstruction surgery by using T-tube ileostomy was conducted between January 1990 and January 2013.The pathologies of the intestinal obstruction were; thirty four of jejunoileal atresia cases, thirteen case meconium ileus, eight cases perforated necrotizing enterocolitis (NEC), three cases meconium peritonitis, three cases with bowel resection due to intestinal volvulus, and one case of gastroschisis. Results: Mean duration of T-tube placement was 13 days (range9-20days) and the sites of T-tube insertion closed spontaneously in 2 days (range 1-4 days). The mean duration for starting oral intake postoperatively in these patients was 9 days (6-16 days). All patients well tolerated the procedure and there were no serious complications related to the T-tube insertion. However, four patients died due to other reasons like sepsis, respiratory failure and prematurity. Conclusion: T-tube enterostomy is an effective and safe technique for treatment of selected cases of neonatal intestinal surgery. It showed less morbidity and mortality rates than the conventional stoma. Therefore, it is considered a helpful approach in cases where there is danger of hypoperistaltic dilated bowel proximal to the anastomosis.
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PMID:Use of T-Tube Enterostomy in Neonatal Gastro-intestinal Surgery. 2789 54