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Epidemiology of congenital diaphragmatic hernia, esophageal atresia, and gastroschisis in South Brazil 巴西南部先天性膈疝、食管闭锁和腹裂的流行病学
Q4 Medicine Pub Date : 2023-04-12 DOI: 10.47338/jns.v12.1199
Background: Birth defects remain a major contributor to infant mortality and lifelong disabilities. The epidemiology of congenital abnormalities varies around the world and little information is available from Latin America.Methods: This is an epidemiological, descriptive, cross-sectional study with data from the Department of Informatics of the Unified Health System (DATASUS) on Congenital diaphragmatic hernia (CDH), esophageal atresia (EA) and gastroschisis (GS) in South Brazil from 2009 to 2019.Results: The incidence of CDH is 0.93 cases, while EA is 0.47 and GS is 2.87, all per 10,000 live births. There is an association between all the malformations and premature birth, cesarean delivery, low birth weight, and low Apgar scores. Both EA and GS are associated with maternal age, EA with older, and GS with younger mothers. While EA is associated with multiple pregnancies, GS is associated with fewer years of maternal formal education, single parenting, and a lower number of prenatal consultations. CDH is associated with the male sex and black ethnicity.Conclusion: This large population-based study estimates the prevalence and demographic factors associated with CDH, EA, and GS, and extends the limited descriptive epidemiologic information available.
背景:出生缺陷仍然是造成婴儿死亡率和终身残疾的主要原因。先天性畸形的流行病学在世界各地各不相同,拉丁美洲的信息很少。方法:这是一项流行病学、描述性、横断面研究,使用了统一卫生系统信息学部(DATASUS)关于先天性膈疝(CDH)的数据,结果:CDH的发生率为0.93例,EA为0.47例,GS为2.87例,均为每10000活产。所有畸形与早产、剖宫产、低出生体重和低Apgar评分之间存在关联。EA和GS都与母亲年龄有关,EA与年龄较大的母亲有关,GS与年龄较小的母亲有关。虽然EA与多胎妊娠有关,但GS与母亲接受正规教育的年限较少、单亲和产前咨询次数较少有关。CDH和男性和黑人种族有关。结论:这项基于人群的大型研究估计了CDH、EA和GS的患病率和人口统计学因素,并扩展了有限的描述性流行病学信息。
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引用次数: 0
Poor outcomes in congenital short bowel syndrome with intestinal malrotation: Experience from a developing country 先天性短肠综合征伴肠道旋转不良的不良预后:来自发展中国家的经验
Q4 Medicine Pub Date : 2023-04-04 DOI: 10.47338/jns.v12.1182
R. Lamiri, Ghada Habachi, Nahla Hmidi, N. Kechiche, Mabrouk Abdelaali, Seifeddine Zayani, A. Ksia, L. Sahnoun, M. Mekki, M. Belghith
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引用次数: 0
Factors associated with cholestasis after surgery for congenital duodenal atresia 先天性十二指肠闭锁术后胆汁淤积的相关因素
Q4 Medicine Pub Date : 2023-03-23 DOI: 10.47338/jns.v12.1158
Y. Minami, Takiguchi Kazuaki, H. Shimizu, Hideaki Tanaka
Background: This study assessed the characteristics of neonates with duodenal atresia (DA) who developed transient postoperative cholestasis which resolved spontaneously, without identifiable congenital anomalies or surgical complications, and identified potential risk factors for cholestasis.Methods: Neonates with DA who underwent surgery at our institution between January 2009 and July 2022 were retrospectively reviewed. Demographic factors, intraoperative findings, placement of a trans-anastomotic tube (TAT), and postoperative outcomes were compared between patients who developed cholestasis (conjugated hyperbilirubinemia >2.0 mg/dL) after surgery (Group A) and those who did not (Group B). This report is a retrospective cohort study and complies with the STROBE statement.Results: Among 19 neonates with DA, 6 (31.6%) developed cholestasis after surgery, with the highest direct bilirubin value being 4.3 (2.4-6.5) mg/dL (median, [range]) on postoperative day 14.5 (2-23) that persisted for 67 (47-116) days until spontaneous resolution. Neonates in Group A had a significantly younger gestational age (36.6 vs. 38.0 weeks) (median) (p=0.038), a higher rate of Down syndrome (66.7 vs. 15.4%) (p=0.046), a higher rate of TAT placement (66.7 vs. 15.4%) (p=0.046), and longer administration of total parenteral nutrition (15.5 vs. 7.0 days) (p=0.027) than those in Group B.Conclusion: Transient cholestasis after surgery for DA seemed to be associated with prematurity, Down syndrome, parenteral nutrition, and TAT placement.
背景:本研究评估了十二指肠闭锁(DA)新生儿术后出现暂时性胆汁淤积的特点,这些胆汁淤积可自行解决,没有可识别的先天性异常或手术并发症,并确定了胆汁淤积的潜在危险因素。方法:对2009年1月至2022年7月在我院接受手术的DA新生儿进行回顾性分析。比较术后出现胆汁淤积(合并高胆红素血症>2.0 mg/dL)的患者(a组)和未出现胆汁淤积的患者(B组)的人口统计学因素、术中发现、经吻合口插管(TAT)的放置和术后结果。本报告是一项回顾性队列研究,符合STROBE声明。结果:在19例DA新生儿中,6例(31.6%)在手术后出现胆汁淤积,术后第14.5天(2-23)的最高直接胆红素值为4.3(2.4-6.5)mg/dL(中位数,[范围]),持续67(47-116)天,直到自发消退。A组新生儿的胎龄明显较低(36.6 vs.38.0周)(中位数)(p=0.038),唐氏综合征发生率较高(66.7 vs.15.4%)(p=0.046),TAT植入率较高(6.67 vs.154%)(p=0.046),与B组相比,全肠外营养给药时间更长(15.5天vs.7.0天)(p=0.027)。结论:DA手术后的短暂性胆汁淤积似乎与早产、唐氏综合征、肠外营养和TAT放置有关。
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引用次数: 0
Experience with endoluminal vacuum therapy in the management of esophageal anastomotic leakage in newborns with esophageal atresia: A case series 腔内真空治疗新生儿食管闭锁食管吻合口瘘的经验:一个病例系列
Q4 Medicine Pub Date : 2023-03-03 DOI: 10.47338/jns.v12.1162
Carolina Santamaría-Proaño, Diego León-Ochoa, Vicente Salinas-Salinas, Daniel Acosta-Bowen, Daniel Acosta-Farina
Background: The management of dehiscence of esophageal anastomosis is challenging and requires a multidisciplinary approach. Endoluminal vacuum therapy (EVT) has shown promising results.Case Presentation: Herein we present the data of two cases with esophageal atresia who developed esophageal anastomotic leakage, during 2021-2022, and who underwent EVT. The first case had 60% dehiscence of the anastomosis, anastomotic leak repair was performed followed by esophageal EVT placement. In the second case, the dehiscence was limited to 10%, and only esophageal EVT was provided. Within four and six days of EVT, upper gastrointestinal endoscopy and fluoroscopy were performed which showed tissue proliferation in situ and the absence of contrast leakage. Both patients were able to resume oral tolerance on the 4th day.Conclusion: Esophageal EVT has shown promising results in the management of esophageal anastomotic leakage in newborns with esophageal atresia.
背景:食管吻合口破裂的治疗具有挑战性,需要多学科联合治疗。腔内真空治疗(EVT)已显示出良好的效果。病例介绍:在此,我们报告了两例食管闭锁并发食管吻合口漏的病例,于2021-2022年期间进行了EVT。1例吻合口裂开60%,行吻合口漏修补术后食管EVT置入术。第二例为裂孔10%,仅行食管EVT。EVT术后4天、6天分别行上消化道内窥镜和透视检查,发现组织原位增生,无造影剂渗漏。两例患者均能在第4天恢复口服耐受。结论:食管EVT在新生儿食管闭锁食管吻合口瘘的治疗中有良好的效果。
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引用次数: 0
Nucleated red blood cells as a potential biomarker for predicting spontaneous intestinal perforation in premature infants 有核红细胞作为预测早产儿自发性肠穿孔的潜在生物标志物
Q4 Medicine Pub Date : 2023-01-31 DOI: 10.47338/jns.v12.1159
M. O’Neill, Roia Katebian, Mollie Shutter, A. Wozniak, P. Dechristopher, L. Glynn, M. Weiss, J. Muraskas
Background: The specific etiology of spontaneous intestinal perforation (SIP) and necrotizing enterocolitis (NEC) remains elusive. Both can present acutely without antecedent signs and can be difficult to differentiate. Neonatal nucleated red blood cell (NRBC) counts are part of the routine admission and serial CBCs drawn on premature neonates. Elevated NRBC counts could represent relative intrauterine hypoxemia, a possible risk factor for the development of SIP or NEC.Methods: We compared premature neonates with SIP to premature neonates with NEC and controls, matched gestational age (GA) and birth weight (BW). Kruskal-Wallis, Chi-Square, or Fisher's exact tests and univariate and multivariate nominal logistic regression models were used to estimate the association of baseline NRBC. Median times to SIP and NEC were calculated using the Kaplan-Meier method. All analyses were performed with SAS 9.4.Results: Male sex (72.5%), lower GA [Median (Q1, Q3): 25.1 (23.8, 28)], and lower BW [Median (Q1, Q3): 690 g (585, 1072)] had the highest incidence of SIP compared to NEC or controls. Increased baseline NRBC was associated with lower odds of developing NEC compared to controls [Median (Q1, Q3): 9 (5, 29) vs 19 (10, 51); OR (CI) 0.70 (0.55, 0.89), p-value = 0.0033]. Increased baseline NRBC was associated with higher odds of developing SIP compared to NEC [Median (Q1, Q3): 9 (5, 29) vs 19 (10, 51); OR (CI) 1.61 (1.18, 2.20) p-value = 0.0027]. There were no significant differences between intrauterine growth restriction (IUGR), maternal hypertension, chorioamnionitis, multiple births, or depressed APGAR scores in all three groups. NRBC for SIP neonates remained significantly higher at the day of life (DOL) 1-3 compared to other groups [Median (Q1, Q3): 23 (6, 93), p-value = 0.0020]. The percentage of patients with NRBC >4, remained elevated for patients with SIP as late as week three (p = 0.0023).Conclusion: ELBW, male sex, and elevated baseline NRBC were significantly associated with the risk of developing SIP compared to NEC or controls. NRBC remained significantly elevated on DOL 1-3, compared to NEC or controls. Between the groups, there were no significant differences in perinatal stressors.
背景:自发性肠穿孔(SIP)和坏死性小肠结肠炎(NEC)的具体病因尚不明确。两者都可以在没有先前迹象的情况下急性出现,并且很难区分。新生儿有核红细胞(NRBC)计数是早产儿常规入院和连续CBC的一部分。NRBC计数升高可能代表相对宫内低氧血症,这可能是发生SIP或NEC的危险因素。方法:我们比较了患有SIP的早产儿与患有NEC的早产儿以及对照组、匹配胎龄(GA)和出生体重(BW)。Kruskal-Wallis、Chi Square或Fisher精确检验以及单变量和多变量标称逻辑回归模型用于估计基线NRBC的相关性。使用Kaplan-Meier方法计算SIP和NEC的中位时间。所有分析均采用SAS进行。9.4.结果:与NEC或对照组相比,男性(72.5%)、较低GA[中位数(Q1,Q3):25.1(23.8,28)]和较低BW[中位数(Q1Q3):690 g(5851072)]的SIP发生率最高。与对照组相比,基线NRBC增加与发生NEC的几率较低相关[中位数(Q1,Q3):9(5,29)vs 19(10,51);OR(CI)0.70(0.55,0.89),p值=0.0033]。与NEC相比,基线NR BC增加与发生SIP的几率较高相关[中位数三组中宫内生长受限(IUGR)、母体高血压、绒毛膜羊膜炎、多胞胎或APGAR评分下降之间的差异。与其他组相比,SIP新生儿在出生日(DOL)1-3的NRBC仍显著升高[中位数(Q1,Q3):23(6,93),p值=0.0020]。SIP患者NRBC>4的患者百分比在第三周仍升高(p=0.0023)。结论:ELBW,男性,与NEC或对照组相比,基线NRBC升高与发展为SIP的风险显著相关。与NEC或对照组相比,DOL 1-3的NRBC仍显著升高。两组之间围产期压力源没有显著差异。
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引用次数: 0
Short Bowel Syndrome in neonates and early infancy 新生儿和早期婴儿的短肠综合征
Q4 Medicine Pub Date : 2023-01-14 DOI: 10.47338/jns.v12.1148
S. Dogra, N. Peters, R. Samujh
Short bowel syndrome (SBS) is the commonest cause of intestinal failure in neonates. SBS results from widespread damage to the small intestine, leading to loss of functional capacity of this organ. This is generally secondary to conditions like necrotizing enterocolitis, gastroschisis, intestinal atresia, and midgut volvulus. The small bowel usually adapts to this damage in due course of time. The clinician's role usually entails the management of parenteral nutrition and the fluid and electrolyte balance to tide over this phase. The management should be initiated as soon as the diagnosis is suspected, especially post-surgical resection of the bowel. This should comprise enteral nutrition, with proactive monitoring and supplementation of electrolytes and micronutrients. Intestinal lengthening procedures like the Serial transverse enteroplasty (STEP), and Longitudinal intestinal lengthening and tailoring (LILT) may be considered in infants, where medical therapy fails to correct the pathology. The intricate nature of the condition warrants a multi-disciplinary approach, involving clinicians, intensivists, and surgeons, which ensures the best neonatal outcomes, in terms of the survival rates in these babies.
短肠综合征(SBS)是新生儿肠衰竭最常见的原因。SBS是由小肠的广泛损伤引起的,导致该器官的功能丧失。这通常继发于坏死性小肠结肠炎、胃裂、肠闭锁和中肠扭转等情况。小肠通常会在适当的时候适应这种损伤。临床医生的角色通常需要管理肠外营养和液体和电解质平衡,以渡过这一阶段。一旦怀疑诊断,应立即开始处理,特别是在手术切除肠道后。这应包括肠内营养、主动监测和补充电解质和微量营养素。对于药物治疗无法纠正病理的婴儿,可以考虑采用连续横向肠成形术(STEP)和纵向肠延长剪裁术(LILT)等肠道延长手术。这种复杂的情况需要多学科的方法,包括临床医生、重症监护医生和外科医生,以确保这些婴儿存活率方面的最佳新生儿结局。
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引用次数: 0
Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report 1.2kg早产新生儿并发持续性肺气肿和气腹的大面积漏气的处理:一例报告
Q4 Medicine Pub Date : 2023-01-10 DOI: 10.47338/jns.v12.1165
H. Woodun, Jeremy M. Thomas, D. Batra, N. Fraser
Background: Pneumothorax is a life-threatening condition with potential iatrogenic causes which can extend to pneumomediastinum and pneumoperitoneum.  Risk factors of spontaneous pneumothorax include prematurity, low birth weight, low APGAR scores, and cesarean-section delivery.Case Presentation: A 1255 grams preterm boy (Twin-2) was born at 28+3 weeks of gestation by emergency lower segment cesarean section. He showed signs of respiratory distress after uncomplicated endotracheal tube insertion which was required due to apneic episodes during continuous positive airway pressure ventilation. Recurring tube thoracocentesis and high-frequency oscillatory ventilation (HFOV) treated persistent right-sided pneumothorax and nonsurgical pneumoperitoneum, with improvement on day 10, gradual removal of five chest drains by day 19, and extubation on day 24. Transillumination and chest radiography were the main diagnostic investigations. Laryngotracheobronchoscopy on day 16 identified erythema and possible old injury at the carina. He was also treated for hypotension, suspected sepsis, and pulmonary hypertension and was discharged home on day 66.Conclusion: Identifying pneumothorax promptly is essential to reduce morbidity and mortality. Management is patient-specific and includes needle and tube thoracocentesis and often, mechanical ventilation. Our case demonstrates the challenges of managing a massive air leak in a premature newborn, who with adequate tube thoracocentesis and HFOV, successfully recovered from presumed iatrogenic persistent pneumothorax and pneumoperitoneum.
背景:气胸是一种危及生命的疾病,具有潜在的医源性原因,可扩展到纵隔气和气腹。自发性气胸的危险因素包括早产、低出生体重、低APGAR评分和剖宫产。病例介绍:一名1255克早产男婴(双胞胎-2)在妊娠28+3周通过紧急下段剖宫产出生。患者在持续气道正压通气时因呼吸暂停发作而需插入气管内插管后出现呼吸窘迫的迹象。反复胸腔插管和高频振荡通气(HFOV)治疗持续性右侧气胸和非手术气腹,第10天改善,第19天逐渐清除5个胸腔引流管,第24天拔管。透视和胸片是主要的诊断手段。第16天喉气管支气管镜检查发现在隆突处有红斑和可能的旧损伤。患者同时接受低血压、疑似脓毒症和肺动脉高压治疗,并于第66天出院。结论:及时发现气胸对降低发病率和死亡率至关重要。治疗是针对患者的,包括针管胸腔穿刺术和机械通气。我们的病例展示了处理大量空气泄漏的挑战,早产新生儿通过适当的管胸穿刺和HFOV,成功地从假定的医源性持续性气胸和气腹中恢复。
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引用次数: 0
Spontaneous perforation of Meckel’s diverticulum causing a partial small bowel obstruction: A case report 自发性梅克尔憩室穿孔引起部分小肠梗阻1例
Q4 Medicine Pub Date : 2023-01-09 DOI: 10.47338/jns.v12.1127
Simran Koura, Veronica M. Urbik, R. Overman, R. Olson, M. Herco, S. Longshore
Background: Meckel’s diverticulum is a common congenital malformation in young children. Perforation of Meckel’s diverticulum in a neonate is a rarity and poses diagnostic and management challenges.Case Presentation: This patient is a former 26 5/7 week estimated gestational age infant who presented at 41 weeks corrected gestational age with abdominal distension and was discovered to have a perforated Meckel’s diverticulum that presented as a partial small bowel obstruction. Resection of the involved bowel and ileo-ileal anastomosis was performed.Conclusion: Small bowel obstructions should be considered as a potential presentation of a perforated Meckel’s diverticulum.
背景:梅克尔憩室是一种常见的幼儿先天性畸形。新生儿Meckel憩室穿孔是罕见的,并对诊断和管理提出了挑战。病例介绍:该患者为前26 5/7周估计胎龄婴儿,在41周校正胎龄时出现腹胀,并被发现有穿孔的Meckel憩室,表现为部分小肠梗阻。切除受累的肠和回肠-回肠吻合。结论:小肠梗阻应被视为梅克尔憩室穿孔的潜在表现。
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引用次数: 0
A case of Aphallia associated with neonatal intestinal obstruction 新生儿肠梗阻伴尿毒症1例
Q4 Medicine Pub Date : 2023-01-06 DOI: 10.47338/jns.v12.1119
Omar Ajaj
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引用次数: 0
Triple atresia: Staged repair 三闭锁:分阶段修复
Q4 Medicine Pub Date : 2023-01-03 DOI: 10.47338/jns.v12.1105
Meryem Unal, Muhammad Fadli Abdullah, Hazlina Mohd Khalid, Mughni Bahari
{"title":"Triple atresia: Staged repair","authors":"Meryem Unal, Muhammad Fadli Abdullah, Hazlina Mohd Khalid, Mughni Bahari","doi":"10.47338/jns.v12.1105","DOIUrl":"https://doi.org/10.47338/jns.v12.1105","url":null,"abstract":"","PeriodicalId":34201,"journal":{"name":"Journal of Neonatal Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43249437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Neonatal Surgery
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