RESUMO
BACKGROUND: A sutureless ward reduction (SWR) protocol was implemented in the neonatal intensive care unit of a tertiary level hospital in 1999. Although the short-term outcomes associated with SWR have been documented, the long-term outcomes are unknown. METHODS: Retrospective data were collected from the medical records of all neonates with gastroschisis from September 1999 to December 2010. Data on their growth and development and the prevalence of any health problems were collected. RESULTS: Eighty-eight patients with gastroschisis were managed over an 11 year period. Forty-four of these patients received SWR, with 2 deaths in the neonatal period. In the 42 survivors, 35 patients were reviewed at a median age of 7 years and 10 months (range, 6-134 months; interquartile range, 37-124 months). One patient experienced failure to thrive and developmental delay, and later died of a medical complication. Thirty-two patients (91.4%) developed an umbilical hernia, only 2 of whom required umbilical herniotomy. Four patients (11.4%) developed small bowel obstruction, all within the first year. CONCLUSION: Most patients with SWR exhibited normal growth with minimal bowel complications. Despite the high incidence of umbilical hernia, the majority resolved spontaneously and did not require subsequent herniotomy.
Assuntos
Técnicas de Fechamento de Ferimentos Abdominais , Gastrosquise/cirurgia , Terapia Intensiva Neonatal/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/etiologia , Insuficiência de Crescimento/epidemiologia , Insuficiência de Crescimento/etiologia , Feminino , Seguimentos , Hérnia Umbilical/epidemiologia , Hérnia Umbilical/etiologia , Hérnia Umbilical/cirurgia , Herniorrafia , Humanos , Incidência , Recém-Nascido , Doenças do Prematuro/cirurgia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Hipertensão Intra-Abdominal/prevenção & controle , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Sepse/epidemiologia , Sepse/etiologia , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do TratamentoRESUMO
Negative pressure wound therapy (NPWT) is an accepted form of treatment in managing complex wounds in adults and children. It is not as widely used in the neonatal population due to limited clinical experience. We describe the application of the RENASYS™ system (Smith and Nephew, UK) in delivering NPWT to four neonates with complex gastroschisis, all of whom achieved successful outcomes.
