[Prognostic factors related to mortality in newborns with jejunoileal atresia]. / Factores pronóstico para mortalidad en neonatos con atresia intestinal yeyuno-ileal.

BACKGROUND: Jejuno-ileal atresia is one of the main causes of intestinal obstruction in neonates. The origin is vascular accidents in the fetal intestine. It is an entity that requires early and specialist management. OBJECTIVE: to know the factors related to mortality in neonates with jejunoileal atresia. METHODS: Case-control nested in a cohort design, comparative study during ten years, between deceased and survivors analyzing factors related to mortality before surgery and during surgery and in the postoperative course. RESULTS: We analyzed 70 patients in 10 years, there were 10 deaths (14.2%). No one had a prenatal diagnosis. Factors related to mortality were: intestinal perforation with a relative risk (RR) of 4.4, peritonitis (RR: 5.6), the need of stomas (RR: 4.9), the presence of sepsis (RR: 4.6) and when the residual small bowel length was below 1 meter (RR: 7.4). CONCLUSION: The delay in diagnosis causes late intervention and increased mortality delayed diagnosis promotes late transport of the neonate and enhances mortality, factors associated with mortality related to intestinal perforation. It is necessary to spread this disease in the medical community to improve prenatal and postnatal diagnosis.

Congenital intrinsic intestinal obstruction in a Caribbean country.

This study was undertaken to evaluate the clinical characteristics, perioperative features, and outcome of congenital intrinsic intestinal obstruction in a developing Caribbean country for comparison with previous literature reports. This study included retrospective data collection on all infants referred to the hospital with a diagnosis of congenital intrinsic bowel obstruction during the period 1999-2006. Data studied were demographic features, perioperative details, surgical procedures performed, postoperative course, and early outcome. Twenty-two infants were treated, with an incidence of 3.14 per 10,000 live births. Duodenal outnumbered jejuno-ileal lesions by 1.5 to 1. Complications occurred in 68.2% of cases, and the mortality rate was 27.3%. Lower gestational age, a high leukocyte count, and more distal small bowel obstruction were significantly associated with mortality. Improvement in the outcome of surgical treatment of this problem in this population requires more effective perioperative management of prematurity and sepsis.

Comorbilidad y letalidad en el primer año de vida en niños con atresia yeyunoileal / Co-morbidity and mortality during the first year of life in children with jejunoileal atresia

Objective. To identify the co-morbidity and mortality during the first year of life in children with jejunoileal atresia. Design. Descriptive, comparative cohort. Site. Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social. Population. Seventy children with jejunoileal atresia. Measures. Following variables were registered: gestational age, birth weight, sex, type and site of atresia, other congenital defects, surgical management, number of surgeries, duration of fasting, re-hospitalizations, weight and height at 6 months and one year of life, co-morbidity and mortality. Results. Intestinal atresia types I and II were present in 27% of the patients respectively and type IIIa in 24%. Co-morbidity in the neonatal period was 64.2%, being the most common conditions sepsis (47.1%) and anastomotic stricture (18.5%). During the first year of life co-morbidity was 51.4%, presented as functional intestinal obstruction (21.4%). Mortality was 11.4% (n = 8), the main causes of death were sepsis (n = 6) and liver failure (n = 2). The mortality rate according to the type of atresia was 44.4% for type IV, 33.3% for type IIIb and 1.3% for type I. Conclusions. Co-morbidity during the first year of life in children with jejunoileal atresia is high, and related to infections and anastomosis inherent problems. Mortality is higher for intestinal atresia type IV.

Objetivo. Identificar la comorbilidad y la letalidad durante el primer año de vida en niños con atresia yeyunoileal. Diseño. Cohorte descriptiva, comparativa. Lugar. Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS. Pacientes. Se estudiaron 70 niños. Mediciones. Se registraron las siguientes variables: edad gestacional, peso al nacimiento, sexo, tipo de atresia, sitio de la atresia, malformaciones asociadas, tratamiento quirúrgico, reintervenciones quirúrgicas, tiempo de ayuno, rehospitalizaciones, peso y talla a los seis meses y al año de edad, comorbilidad y letalidad. Resultados. La atresia tipo I y II se presentaron en 27% cada una y la tipo IIIa en 24%. La comorbilidad en el periodo neonatal fue de 64.2%, las causas más frecuentes fueron sepsis (47.1%) y estenosis de la anastomosis (18.5%) y en el primer año de vida fue de 51.4%; la causa más frecuente fue oclusión intestinal funcional (21.4%). La letalidad fue de 11.4% (n = 8); las principales causas de muerte fueron sepsis (n = 6), e insuficiencia hepática (n = 2). La letalidad por tipo de atresia fue de 44.4% en la tipo IV, 33.3% en la IIIb y 10.5% en la tipo I. Conclusiones. La comorbilidad en el primer año de vida en niños con atresia intestinal fue elevada, las principales causas fueron infecciosas y problemas inherentes a la anastomosis. La atresia con mayor letalidad fue la tipo IV.

[Co-morbidity and mortality during the first year of life in children with jejunoileal atresia]. / Comorbilidad y letalidad en el primer año de vida en niños con atresia yeyunoileal.

OBJECTIVE: To identify the co-morbidity and mortality during the first year of life in children with jejunoileal atresia. DESIGN: Descriptive, comparative cohort. SITE: Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social. POPULATION: Seventy children with jejunoileal atresia. MEASURES: Following variables were registered: gestational age, birth weight, sex, type and site of atresia, other congenital defects, surgical management, number of surgeries, duration of fasting, re-hospitalizations, weight and height at 6 months and one year of life, co-morbidity and mortality. RESULTS: Intestinal atresia types I and II were present in 27% of the patients respectively and type IIIa in 24%. Co-morbidity in the neonatal period was 64.2%, being the most common conditions sepsis (47.1%) and anastomotic stricture (18.5%). During the first year of life co-morbidity was 51.4%, presented as functional intestinal obstruction (21.4%). Mortality was 11.4% (n = 8), the main causes of death were sepsis (n = 6) and liver failure (n = 2). The mortality rate according to the type of atresia was 44.4% for type IV, 33.3% for type IIIb and 1.3% for type I. CONCLUSIONS: Co-morbidity during the first year of life in children with jejunoileal atresia is high, and related to infections and anastomosis inherent problems. Mortality is higher for intestinal atresia type IV.

Cirugía neonatal: experiencia de 10 años / Neonatal surgery: 10 years experience

Se presentan 504 recién nacidos, operados dentro de los primeros 28 días de vida, en el Departamento de Cirugía Pediátrica del Hospital "San Bartolomé", por ser portadores de alguna anomalía congénita quirúrgica, desde Enero de 1982 hasta Diciembre de 1991 (10 años). Evaluamos la incidencia, anomalías asociadas, procedimientos quirúrgicos y mortalidad de todas las malformaciones congénitas quirúrgicas operadas comparándolas con otras series. La patología más frecuente fue la malformación anorectal con 182 casos (33,33 por ciento); seguida de las atresias y estenosis intestinales, 138 casos (25,27 por ciento) y la atresia de esófago con FTE distal, 70 casos (12,82 por ciento). Entre estos tres diagnósticos se reúne al 71,42 por ciento de toda la casuística revisada. De los 504 recién nacidos operados sobrevivió el 56 por ciento (282); falleció el 39 por ciento (196) y en 5 por ciento (26) no fue posible obtener este dato. Resaltamos el hecho de que la mortalidad es absoluta. No discriminamos a los neonatosexpresando nuestra mortalidad global en forma no selectiva

[Intestinal atresia]. / Atresia intestinal.

The authors reviewed their experience with 20 cases of intestinal atresia (jejunum, ileum and colon) admitted between January 1972 and January 1977. International literature shows 80% mortality rate for this malformation before 1940 and 10-25% in current reports. In Mexico, before 1959, the mortality rate was 80%, but the most recent reports showed 28% mortality rate for atresia and 33% in cases of stenosis. The group of patient studied included twelve cases with a weight over 2,500 g. and eight patients under 2,500 g. Four patients showed multiple associated malformations (incompatible with life in one case) and in 17, there were no associated malformations. Nineteen cases were operated, the dilated and atresic segments were resected and anastomosis was performed. It was termino-terminal in 13 cases and termino-lateral in 6. One case was explored surgically and no attempt to repair the atresias was made, because there were malformations incompatible with life. Four patients died. Even if this series is very small, the associated malformations, low weight and techniques used do not seem to influence the prognosis of these patients.