Association between prognostic factors and the clinical deterioration of preterm neonates with necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) is responsible for most morbidity and mortality in neonates. Early recognition of the clinical deterioration in newborns with NEC is essential to enhance the referral and management and potentially improve the outcomes. Here, we aimed to identify the prognostic factors and associate them with the clinical deterioration of preterm neonates with NEC. We analyzed the medical records of neonates with NEC admitted to our hospital from 2016 to 2021. We ascertained 214 neonates with NEC. The area under the receiver operating characteristic (ROC) curve and cut-off level of age at onset, C-reactive protein (CRP), leukocyte count, and platelet count for the clinical deterioration of preterm neonates with NEC was 0.644 and 10.5 days old, 0.694 and 4.5 mg/L, 0.513 and 12,200/mm3, and 0.418 and 79,500/mm3, respectively. Late-onset, history of blood transfusion, thrombocytopenia, and elevated CRP were significantly associated with the clinical deterioration of neonates with NEC (p = < 0.001, 0.017, 0.001, and < 0.001, respectively), while leukocytosis, gestational age, and birth weight were not (p = 0.073, 0.274, and 0.637, respectively). Multivariate analysis revealed that late-onset and elevated CRP were strongly associated with the clinical deterioration of neonates with NEC, with an odds ratio of 3.25 (95% CI = 1.49-7.09; p = 0.003) and 3.53 (95% CI = 1.57-7.95; p = 0.002), respectively. We reveal that late-onset and elevated CRP are the independent prognostic factor for the clinical deterioration of preterm neonates with NEC. Our findings suggest that we should closely monitor preterm neonates with NEC, particularly those with late-onset of the disease and those with an elevated CRP, to prevent further clinical deterioration and intervene earlier if necessary.

Volvulus Due to Mesenteric Cysts in Infants and Children; A Case Report.

Mesenteric cysts are defined as benign intra-abdominal tumors located in the mesentery. It was a rare disease with an incidence of 1:20000 in children. The most common location was in the small bowel mesentery. Most patients with mesenteric cysts are asymptomatic and have unspecific symptoms like dyspepsia, abdominal enlargement, and abdominal pain. The fewer others could present with an acute abdomen. We describe two cases of volvulus due to the mesenteric cyst; one case in an infant and one case in a child. There is a different clinical presentation and histopathology between infants and children. In the infant, it presented with an acute abdomen, while in the child acute abdomen was not present. We found a chylous cyst in the child while the enterogenous cyst was present in the infant. We found a volvulus due to the mesentery cyst in the infant. This comparison of mesenteric cysts between the infant and the child could help to diagnose mesenteric cysts, especially in infants.

Left-side incarcerated Amyand's hernia with appendix and caecum provoke by early banana diet: a case report.

BACKGROUND: Amyand's hernia was an unusual condition defined by the presence of an appendix located in the inguinal hernia sac. Its prevalence was 1% of all inguinal hernia in children. The clinical manifestation of Amyand's hernia was depending on hernia's stage, an incarcerated hernia will present with an inguinal mass following by pain and motility disorder. It could lead to abdominal distention in the late stage. The common location of Amyand's hernia was on the right side, the left side was uncommon. Early feeding on infants could provoke symptoms of bowel obstruction (SBO). More than 76% of infants in Java, Indonesia was given banana as solid food in infants before six months old. There is a correlation between the early banana diet and SBO. Amyand's hernia could present as morbidity of early banana diet. CASE PRESENTATION: We describe a case of two months old infant present with an incarcerated left inguinal hernia and history of early banana diet that performed herniotomy procedure. During the operation, we found left-side incarcerated Amyand's hernia with appendicitis, excoriation caecum, and sticky banana mass. CONCLUSION: This case suggest the possibility of early feeding of banana diet may provoke incarceration of an inguinal hernia and if the incarcerated hernia content contains the appendix, then an Amyand's hernia.