Background: Strategies for the surgical management of necrotising enterocolit is are various and controversial. Objective: To characterise variation in surgic al management of this disease across the United Kingdom. M...Background: Strategies for the surgical management of necrotising enterocolit is are various and controversial. Objective: To characterise variation in surgic al management of this disease across the United Kingdom. Methods: Postal survey of 104 consultant paediatric surgeons with a 77% response rate. Results: Durat ion of antibiotic treatment (median 10 days, range 6- 14), time until the start of enteral feeding (median 10 days, range 4- 21), and absolute indications for surgery all vary between surgeons. Peritoneal drainage is used by 95% of surg eons. Forty two percent use it in neonates of all weights, whereas 36% restric t its use to those < 1000 g. Peritoneal drainage is used for stabilisation by 9 5% and as definitive treatment by 58% . At laparotomy, operative procedures i nclude diverting jejunostomy, resection and stoma, resection with primary anasto mosis, and “ clip and drop” . All procedures are used in infants of all weight s except resection and pri mary anastomosis, which is used predominantly in larger infants (55% in < 1 000 g; 77% in > 1000 g; p=0.005). Infants may be considered too unwell for peritoneal drainage by 11% of surgeons compared with 90% for laparotomy (p < 0.0001). Conclusions: There is considerable variation in surgical strategies f or necrotising enterocolitis. Peritoneal drainage is used by most surgeons, with controversial indications and expectations. The use of resection and primary an astomosis is influenced by the weight of the neonate.展开更多
Purpose: The Spitz classification of oesophageal atresia (OA)-based on the birth weight and the presence of a major cardiac anomaly was proposed 1994. Advances in neonatal care have led us to question if these outcome...Purpose: The Spitz classification of oesophageal atresia (OA)-based on the birth weight and the presence of a major cardiac anomaly was proposed 1994. Advances in neonatal care have led us to question if these outcome figures are still valid. We tested the hypothesis that the outcome of neonates with OA has improved during the last decade. Methods: The records of all neonates (n = 188) born with OA and treated in a single institution between 1993 and 2004 were reviewed and compared with data from the original Spitz study. Data were obtained on the birth weight,presence of a major cardiac anomaly,and survival. Differences in survival were compared using the Yates-corrected χ 2 test. Results: In the early period,326 neonates survived (87.6% ) compared with 174 (91.5% ) in the most recent decade (P = 0.10). Based on Spitz classification,the outcome comparing both periods was the following: group I,97% (283/293) and 98.5% (130/132) (P = 0.44); group II,59% (41/70) and 82% (41/50) (P = 0.01); group III,22% (2/9) and 50% (3/6) (P = 0.57),respectively. Conclusions: The Spitz classification remains valid. It may be of use when counselling parents and in comparing outcome among centres. In our centre,the overall survival of neonates with OA has not significantly changed in the recent decade. The improvement in survival of neonates in group II,however,demonstrated the recent advances in neonatal。展开更多
Background: Glutathione (GSH) is the major intracellular antioxidant protecting against free radical-mediated damage. Oxidative stress is implicated in the pathogenesis of necrotizing enterocolitis (NEC), and damage c...Background: Glutathione (GSH) is the major intracellular antioxidant protecting against free radical-mediated damage. Oxidative stress is implicated in the pathogenesis of necrotizing enterocolitis (NEC), and damage could be enhanced by a relative deficiency of GSH.We hypothesized that infants with NEC would have lower levels of erythrocyte GSH when compared with controls. Methods: Total erythrocyte GSH concentration (per gram of hemoglobin g Hb ) was determined in blood samples from infants with NEC (n = 16) referred for surgical intervention. Nonseptic infants referred for other conditions (eg, patent ductus arteriosus ligation) served as controls (n = 10). Results: Controls and infants with NEC were demographically similar. Mean erythrocyte GSH concentration in infants with NEC was 0.076 ±0.004 μmol/g Hb and in controls it was 0.078 ±0.005 μmol/g Hb (P =. 73). There was no significant correlation between GSH concentration and weight, gestational age, or C-reactive protein levels. In infants with NEC, there was no difference in GSH levels between infants with stage 2 and stage 3 diseases nor between those who died and survived, but a trend toward lower GSH levels in infants with more extensive diseases exists. Conclusions: Total GSH levels are similar in infants with NEC and controls. It is possible that a relative rather than absolute deficiency of antioxidant compounds exists and may contribute to the development of NEC.展开更多
文摘Background: Strategies for the surgical management of necrotising enterocolit is are various and controversial. Objective: To characterise variation in surgic al management of this disease across the United Kingdom. Methods: Postal survey of 104 consultant paediatric surgeons with a 77% response rate. Results: Durat ion of antibiotic treatment (median 10 days, range 6- 14), time until the start of enteral feeding (median 10 days, range 4- 21), and absolute indications for surgery all vary between surgeons. Peritoneal drainage is used by 95% of surg eons. Forty two percent use it in neonates of all weights, whereas 36% restric t its use to those < 1000 g. Peritoneal drainage is used for stabilisation by 9 5% and as definitive treatment by 58% . At laparotomy, operative procedures i nclude diverting jejunostomy, resection and stoma, resection with primary anasto mosis, and “ clip and drop” . All procedures are used in infants of all weight s except resection and pri mary anastomosis, which is used predominantly in larger infants (55% in < 1 000 g; 77% in > 1000 g; p=0.005). Infants may be considered too unwell for peritoneal drainage by 11% of surgeons compared with 90% for laparotomy (p < 0.0001). Conclusions: There is considerable variation in surgical strategies f or necrotising enterocolitis. Peritoneal drainage is used by most surgeons, with controversial indications and expectations. The use of resection and primary an astomosis is influenced by the weight of the neonate.
文摘Purpose: The Spitz classification of oesophageal atresia (OA)-based on the birth weight and the presence of a major cardiac anomaly was proposed 1994. Advances in neonatal care have led us to question if these outcome figures are still valid. We tested the hypothesis that the outcome of neonates with OA has improved during the last decade. Methods: The records of all neonates (n = 188) born with OA and treated in a single institution between 1993 and 2004 were reviewed and compared with data from the original Spitz study. Data were obtained on the birth weight,presence of a major cardiac anomaly,and survival. Differences in survival were compared using the Yates-corrected χ 2 test. Results: In the early period,326 neonates survived (87.6% ) compared with 174 (91.5% ) in the most recent decade (P = 0.10). Based on Spitz classification,the outcome comparing both periods was the following: group I,97% (283/293) and 98.5% (130/132) (P = 0.44); group II,59% (41/70) and 82% (41/50) (P = 0.01); group III,22% (2/9) and 50% (3/6) (P = 0.57),respectively. Conclusions: The Spitz classification remains valid. It may be of use when counselling parents and in comparing outcome among centres. In our centre,the overall survival of neonates with OA has not significantly changed in the recent decade. The improvement in survival of neonates in group II,however,demonstrated the recent advances in neonatal。
文摘Background: Glutathione (GSH) is the major intracellular antioxidant protecting against free radical-mediated damage. Oxidative stress is implicated in the pathogenesis of necrotizing enterocolitis (NEC), and damage could be enhanced by a relative deficiency of GSH.We hypothesized that infants with NEC would have lower levels of erythrocyte GSH when compared with controls. Methods: Total erythrocyte GSH concentration (per gram of hemoglobin g Hb ) was determined in blood samples from infants with NEC (n = 16) referred for surgical intervention. Nonseptic infants referred for other conditions (eg, patent ductus arteriosus ligation) served as controls (n = 10). Results: Controls and infants with NEC were demographically similar. Mean erythrocyte GSH concentration in infants with NEC was 0.076 ±0.004 μmol/g Hb and in controls it was 0.078 ±0.005 μmol/g Hb (P =. 73). There was no significant correlation between GSH concentration and weight, gestational age, or C-reactive protein levels. In infants with NEC, there was no difference in GSH levels between infants with stage 2 and stage 3 diseases nor between those who died and survived, but a trend toward lower GSH levels in infants with more extensive diseases exists. Conclusions: Total GSH levels are similar in infants with NEC and controls. It is possible that a relative rather than absolute deficiency of antioxidant compounds exists and may contribute to the development of NEC.
