Surgery is safe in very low birthweight infants with necrotizing enterocolitis.

The aim of this study was to determine how the operative event itself affects very low birthweight (VLBW) infants (< 1500 g) with necrotizing enterocolitis (NEC) undergoing surgery, and to try to identify preventable factors leading to perioperative morbidity and mortality. Eighty-five VLBW infants developed NEC during a 6-year period; 34 of those required emergent celiotomies. Data were collected retrospectively from hospital charts available on 33 infants. Birthweight ranged from 566 g to 1415 g (mean +/- SD: 961+/-262 g) and gestational age from 24 to 34 wk (28+/-3.2 wk). Thirty infants had been fed premature formula (first feed at 5+/-3.6 d) prior to the onset of symptoms and three had not been fed at all. Age at NEC symptoms was 19+/-15 d. Infants < 1000 g developed NEC much longer after the first feed compared to infants > 1000 g (p < 0.002; t-test). In 42% of the children, intraoperative blood pressure fell at least 20% from the preoperative value. Body temperature dropped from a preoperative 36.5+/-0.340 degrees C to 35.5+/-1.20 degrees C (p < 0.005), although in all children two or more heating devices were employed in the operating room. All infants survived the procedure. Six infants with pannecrosis died within 72 h of the operative event. In an appropriate setting, operative intervention under general anesthesia is well tolerated by VLBW infants with NEC. Since hypothermia was a major problem, the authors have modified their approach and now no longer transport these infants to the operating room. Instead, these infants are operated upon in the neonatal intensive care unit, directly on an infant radiant warmer system.

Proctocolitis in exclusively breast-fed infants.

UNLABELLED: We present nine exclusively breast-fed, full-term infants with mild rectal bleeding due to proctocolitis. The mean age at the onset of symptoms was 5 weeks (range 1-8 weeks). Rectosigmoidoscopic examination was performed in all the children within 2 days after admission, showing inflammatory changes such as oedematous mucosa with petechial haemorrhages. Rectal mucosal biopsy specimens were obtained in eight cases and revealed intra-epithelial eosinophilic granulocytes in seven and a diffuse increase of eosinophils in the lamina propria in six. Allergy to cow's milk protein transferred to the infants via the breast milk was believed to be the cause of the inflammation. The intake of cow's milk protein was then restricted in seven mothers. Following this regimen, symptoms were relieved within 4 weeks in the six infants who were seen at follow up. One child recovered spontaneously without dietary restrictions. Considering the beneficial effect of the diet regimen in addition to the histological findings, allergy to cow's milk protein is possibly the aetiology of the proctocolitis seen in these nine exclusively breast-fed babies, although no challenge tests were performed to confirm this suspicion. CONCLUSION: This report shows that proctocolitis occurs in exclusively breast-fed infants. It is speculated that allergy to cow's milk protein may have played a role in the pathogenesis.

Paraumbilical intestinal remnant, closed abdominal wall, and midgut loss in a neonate.

A newborn with a mummified right paraumbilical intestinal remnant, closed abdominal wall, and loss of most of the midgut raises important questions concerning embryonic abdominal wall closure and the intrauterine events leading to gastroschisis and "congenital" short gut syndrome.

Urethral prolapse: an often misdiagnosed cause of urogenital bleeding in girls.

Urethral prolapse is an uncommon disorder in girls, usually presenting as "vaginal" bleeding. This retrospective chart review focuses on the high rate of misdiagnosis of urethral prolapse and describes treatment modalities based on 24 patients seen at a major children's hospital during an 11-year span. Their mean age was 4.9 years. The initial diagnosis, made by the referring pediatrician or emergency physician, was correct in only five girls (21%). Twenty children presented with urogenital bleeding. Operative correction was employed as initial treatment in 16 girls, with one recurrence. The remaining eight children were treated nonoperatively. Of these, five showed no improvement and underwent surgical repair. Although most children eventually require resection of the prolapsed urethral mucosa, nonoperative treatment is appropriate for asymptomatic girls with a mild degree of urethral prolapse. Increased physician awareness of urethral prolapse is desirable to enhance early recognition and to avoid unnecessary examinations and parental concern.

Impaired survival and growth in immunosuppressed young rats with lethal short gut syndrome and a small bowel transplant: an effect of cyclosporine.

Neonates and growing individuals have increased nutritional demands as compared with adults. To determine the functional ability of an intestinal graft to allow survival and growth, an otherwise lethal short gut model should be used (resection of both the entire small bowel and the cecum). In this study the authors investigated the survival and growth in young rats (80 to 125 g) with this lethal short gut syndrome (SGS) and either syngeneic or allogeneic segmental small bowel transplantation (SBTx). Additionally they sought to determine the effect of therapeutical doses of cyclosporine (CyA) in young, growing rats. To avoid total parenteral nutrition in rats undergoing SBTx, surgery was carried out in two steps: after segmental SBTx of a 25-cm jejunal graft, SGS was created 2 weeks later. Lewis rats underwent 1: Syngeneic segmental SBTx + SGS (n = 7); 2: Allogeneic segmental SBTx (donor: Lewis Brown Norway F1) + SGS + CyA (15 mg/kg/d for 7 days, then every other day for 21 days) (n = 9); 3: Syngeneic segmental SBTx + SGS + CyA as in group 2 (n = 5); 4: SGS alone (n = 5): 5: small bowel resection alone (n = 5); 6: sham laparotomy twice (n = 5); 7: sham laparotomy twice + CyA as in group 2 (n = 6). Weight, general condition, and nutritional serum variables were followed up regularly for 4 months. Rats with resection of small bowel survived but did not grow. Rats with small bowel resection + cecectomy died within 5 days.(ABSTRACT TRUNCATED AT 250 WORDS)