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  • • Most frequent surgical condition in a neonate

    • Associated with multiple comorbidities resulting in mucosal injury of the intestine

    • Most commonly affecting terminal ileum and right colon

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Epidemiology

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  • • 1-3/1000 births and in 30/1000 of low-birth-weight babies

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Symptoms and Signs

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  • • Abdominal distention

    • Feeding intolerance

    • Bilious emesis

    • Occult or gross blood in stool

    • Abdominal tenderness

    • Abdominal wall edema, crepitus, or discoloration (suggest perforation)

    • Temperature instability

    • Apnea

    • Bradycardia

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Laboratory Findings

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  • • Hypoxemia

    • Acidosis

    • Thrombocytopenia

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Imaging Findings

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  • Abdominal x-ray: Shows pneumatosis intestinalis from 20% to 98% of time, thickened loops of bowel, ascites, and portal venous gas; possible pneumoperitoneum

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Rule Out

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  • • Perforation

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  • • History and physical exam

    • ABG measurements

    • CBC

    • Electrolytes

    • Abdominal x-ray

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Surgery

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  • • Exploratory laparotomy if patient decompensates or does not improve after 24-72 hours of medical management, pneumoperitoneum, portal venous gas, abdominal wall erythema, or crepitus; resection of necrotic bowel, proximal enterostomy, and distal mucous fistula

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Medications

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  • • 90% can be managed medically with NG decompression, bowel rest, broad-spectrum antibiotics, and correction of other comorbid conditions

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Complications

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  • • 20-40% complication rate including leak, stomal necrosis, fistula formation, and stricture

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Prognosis

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  • • Mortality rate, 20-40%

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References

Andorsky DJ et al. Nutritional and other postoperative management of neonates with short bowel syndrome correlates with clinical outcomes. J Pediatr. 2001;139:27.  [PubMed: 11445790]
Noble HG, Driessnack M: Bedside peritoneal drainage in very low birth weight infants. Am J Surg 2001;181:416.  [PubMed: 11448432]
Moss RL et al: Laparotomy compared with peritoneal drainage in infants with necrotizing enterocolitis and intestinal perforation. New Engl J Med 2006;354:2225.  [PubMed: 16723614]

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