Hernia

, Volume 18, Issue 3, pp 351–356

Postoperative outcome in premature infants with open abdomen

  • A. Lambertz
  • M. Binnebösel
  • A. Röth
  • T. Orlikowsky
  • U. P. Neumann
  • G. Steinau
  • C. D. Klink
Original Article

Abstract

Background

Premature infants treated with laparostomy in the first days of their life represent a group of complex patients with high morbidity and mortality rates. Laparostomy is a surgical treatment method in which the peritoneal cavity is opened anteriorly and deliberately left open, hence often called “open abdomen”. The aim of this study was to analyze crucial factors influencing the postoperative outcome of premature infants treated this way.

Methods

Between March 2002 and August 2012, we treated 40 premature infants with a median gestational age of 29 weeks (range from 24 to 34 weeks) with open abdomen in our institution. Their data were analyzed retrospectively. They were divided into two groups depending on in-hospital survival.

Results

Indications for surgery were ileus (n = 16), spontaneous intestinal perforation (n = 11), gastroschisis (n = 8) and necrotizing enterocolitis (NEC, n = 5). The overall in-hospital mortality was 43 % (17 of 40 patients). Postoperative anemia was the only significant factor influencing mortality rates in our patients (10 vs. 14 patients; p = 0.028). Neither the indication of surgery, nor week of gestation, nor birth weight had any significant influence on postoperative survival. Twenty-one of the 23 surviving patients reached fascia closure.

Conclusions

In our study, outcome of premature infants with open abdomen in the first days of their life seems to depend more on an operation and a postoperative course without complications than on the preoperative conditions of the children. Postoperative anemia seems to be a significant negative prognostic marker. Patients reaching fascia closure mainly survive.

Keywords

Premature infants Open abdomen Mortality Postoperative outcome Fascia closure 

References

  1. 1.
    Blakely ML, Lally KP, McDonald S, Brown RL, Barnhart DC, Ricketts RR, Thompson WR, Scherer LR, Klein MD, Letton RW, Chwals WJ, Touloukian RJ, Kurkchubasche AG, Skinner MA, Moss RL, Hilfiker ML (2005) Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation: a prospective cohort study by the NICHD Neonatal Research Network. Ann Surg 241:984–989PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    de Souza JC, da Motta UI, Ketzer CR (2001) Prognostic factors of mortality in newborns with necrotizing enterocolitis submitted to exploratory laparotomy. J Pediatr Surg 36:482–486PubMedCrossRefGoogle Scholar
  3. 3.
    Ricketts RR, Jerles ML (1990) Neonatal necrotizing enterocolitis: experience with 100 consecutive surgical patients. World J Surg 14:600–605PubMedCrossRefGoogle Scholar
  4. 4.
    Holman RC, Stoll BJ, Clarke MJ, Glass RI (1997) The epidemiology of necrotizing enterocolitis infant mortality in the United States. Am J Public Health 87:2026–2031PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Uauy RD, Fanaroff AA, Korones SB, Phillips EA, Phillips JB, Wright LL (1991) Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical correlates. National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 119:630–638PubMedCrossRefGoogle Scholar
  6. 6.
    Blakely ML, Tyson JE, Lally KP, McDonald S, Stoll BJ, Stevenson DK, Poole WK, Jobe AH, Wright LL, Higgins RD (2006) Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age. Pediatrics 117:e680–e687PubMedCrossRefGoogle Scholar
  7. 7.
    Ahmed T, Ein S, Moore A (1998) The role of peritoneal drains in treatment of perforated necrotizing enterocolitis: recommendations from recent experience. J Pediatr Surg 33:1468–1470PubMedCrossRefGoogle Scholar
  8. 8.
    Moss RL, Dimmitt RA, Barnhart DC, Sylvester KG, Brown RL, Powell DM, Islam S, Langer JC, Sato TT, Brandt ML, Lee H, Blakely ML, Lazar EL, Hirschl RB, Kenney BD, Hackam DJ, Zelterman D, Silverman BL (2006) Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med 354:2225–2234PubMedCrossRefGoogle Scholar
  9. 9.
    Rao SC, Basani L, Simmer K, Samnakay N, Deshpande G (2011) Peritoneal drainage versus laparotomy as initial surgical treatment for perforated necrotizing enterocolitis or spontaneous intestinal perforation in preterm low birth weight infants. Cochrane Database Syst Rev p CD006182Google Scholar
  10. 10.
    Chandler JC, Hebra A (2000) Necrotizing enterocolitis in infants with very low birth weight. Semin Pediatr Surg 9:63–72PubMedGoogle Scholar
  11. 11.
    Dominguez KM, Moss RL (2012) Necrotizing enterocolitis. Clin Perinatol 39:387–401PubMedCrossRefGoogle Scholar
  12. 12.
    Argumosa SY, Fernandez CMS, Gonzalvez PJ, Hernandez AE, Baquero CM, Medina MC, Rubio RA, Martinez GA (2011) Necrotizing entercolitis and intestinal perforation in very low weight premature infants: which is the best surgical option? Cir Pediatr 24:142–145Google Scholar
  13. 13.
    Bysiek A, Palka J, Pietrzyk JJ, Mitkowska Z, Tomasik T (2002) Peritoneal drainage as an alternative to laparotomy in premature infants with complicated necrotizing enterocolitis. Przegl Lek 59(Suppl 1):67–69PubMedGoogle Scholar
  14. 14.
    Sola JE, Tepas JJ III, Koniaris LG (2010) Peritoneal drainage versus laparotomy for necrotizing enterocolitis and intestinal perforation: a meta-analysis. J Surg Res 161:95–100PubMedCrossRefGoogle Scholar
  15. 15.
    Blakely ML, Gupta H, Lally KP (2008) Surgical management of necrotizing enterocolitis and isolated intestinal perforation in premature neonates. Semin Perinatol 32:122–126PubMedCrossRefGoogle Scholar
  16. 16.
    Guner YS, Friedlich P, Wee CP, Dorey F, Camerini V, Upperman JS (2009) State-based analysis of necrotizing enterocolitis outcomes. J Surg Res 157:21–29PubMedCrossRefGoogle Scholar
  17. 17.
    Luig M, Lui K (2005) Epidemiology of necrotizing enterocolitis—Part II: risks and susceptibility of premature infants during the surfactant era: a regional study. J Paediatr Child Health 41:174–179PubMedCrossRefGoogle Scholar
  18. 18.
    Luig M, Lui K (2005) Epidemiology of necrotizing enterocolitis—Part I: changing regional trends in extremely preterm infants over 14 years. J Paediatr Child Health 41:169–173PubMedCrossRefGoogle Scholar
  19. 19.
    Fitzgibbons SC, Ching Y, Yu D, Carpenter J, Kenny M, Weldon C, Lillehei C, Valim C, Horbar JD, Jaksic T (2009) Mortality of necrotizing enterocolitis expressed by birth weight categories. J Pediatr Surg 44:1072–1075PubMedCrossRefGoogle Scholar
  20. 20.
    Guelfand M, Santos M, Olivos M, Ovalle A (2012) Primary anastomosis in necrotizing enterocolitis: the first option to consider. Pediatr Surg Int 28:673–676PubMedCrossRefGoogle Scholar
  21. 21.
    Hall NJ, Curry J, Drake DP, Spitz L, Kiely EM, Pierro A (2005) Resection and primary anastomosis is a valid surgical option for infants with necrotizing enterocolitis who weigh less than 1000 g. Arch Surg 140:1149–1151PubMedCrossRefGoogle Scholar
  22. 22.
    Ade-Ajayi N, Kiely E, Drake D, Wheeler R, Spitz L (1996) Resection and primary anastomosis in necrotizing enterocolitis. J R Soc Med 89:385–388PubMedCentralPubMedGoogle Scholar
  23. 23.
    Pierro A (2005) The surgical management of necrotising enterocolitis. Early Hum Dev 81:79–85PubMedCrossRefGoogle Scholar
  24. 24.
    Yasmeen BH, Chowdhury MA, Hoque MM, Hossain MM, Jahan R, Akhtar S (2012) Effect of short-term recombinant human erythropoietin therapy in the prevention of anemia of prematurity in very low birth weight neonates. Bangladesh Med Res Counc Bull 38:119–123PubMedGoogle Scholar
  25. 25.
    Soubasi V, Kremenopoulos G, Diamanti E, Tsantali C, Sarafidis K, Tsakiris D (1995) Follow-up of very low birth weight infants after erythropoietin treatment to prevent anemia of prematurity. J Pediatr 127:291–297PubMedCrossRefGoogle Scholar
  26. 26.
    Saager L, Turan A, Reynolds LF, Dalton JE, Mascha EJ, Kurz A (2013) The association between preoperative anemia and 30-day mortality and morbidity in noncardiac surgical patients. Anesth Analg 117:909–915PubMedCrossRefGoogle Scholar
  27. 27.
    Beattie WS, Karkouti K, Wijeysundera DN, Tait G (2009) Risk associated with preoperative anemia in noncardiac surgery: a single-center cohort study. Anesthesiology 110:574–581PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • A. Lambertz
    • 1
  • M. Binnebösel
    • 1
  • A. Röth
    • 1
  • T. Orlikowsky
    • 2
  • U. P. Neumann
    • 1
  • G. Steinau
    • 1
  • C. D. Klink
    • 1
  1. 1.Department of General, Visceral and Transplantation SurgeryRWTH Aachen University HospitalAachenGermany
  2. 2.Neonatology Section, Department of Paediatric and Adolescent MedicineRWTH Aachen University HospitalAachenGermany

Personalised recommendations