Assuntos
Abuso Sexual na Infância/prevenção & controle , Abuso Sexual na Infância/estatística & dados numéricos , Estupro/prevenção & controle , Estupro/estatística & dados numéricos , Atitude Frente a Saúde , Criança , Abuso Sexual na Infância/legislação & jurisprudência , Abuso Sexual na Infância/tendências , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Incesto/prevenção & controle , Incesto/estatística & dados numéricos , Incidência , Avaliação das Necessidades , Estupro/legislação & jurisprudência , Fatores de Risco , África do Sul/epidemiologia , Saúde da MulherRESUMO
In high income countries, mortality of neonates due to necrotizing enterocolitis (NEC) is decreasing due to advances in early detection and sepsis management. Surgical strategies, by and large, are becoming less relevant as the sophistication of intensive care facilities increases in those countries. Management of septic neonates with NEC in low income countries, however, due to inherent resource constraints cannot achieve the same standards as those reported from high income countries. Surgeons therefore play an important role because they can offer different surgical strategies in line with the deficiency of their environment. Over a 4-year period, 172 neonates who had surgery for NEC in a single institution were prospectively followed up. Standard surgical practices of the high income countries were compared to those adopted by the authors. The end point was early mortality, taking into account the anatomical zones of the involved intestine. Survival was increased from 21% to 84% by early surgery and by extending the length of colon resected in cases of ileocolic NEC. In this approach, a short resuscitative period is followed by intestinal resection including most of the diseased colon as well as the perforated/dead bowel. A more modest improvement in survival was noted with a planned re-look laparotomy in neonates with generalized NEC.