Neonatal gastrointestinal perforation in Japan: a nationwide survey.

PURPOSE: The purpose of this study is to identify the current clinical features of neonatal gastrointestinal perforation in Japan. METHODS: A questionnaire about cases of neonatal gastrointestinal perforation treated in recent 5 years was sent to participating institutions of the Japanese Society of Pediatric Surgeons (JSPS). RESULTS: Five hundred and thirty-six neonates with gastrointestinal perforation were treated. They consisted of 42 patients with gastric rupture/perforation (GR), 33 patients with intestinal atresia/stenosis (IA), 3 patients with malrotation (ML), 118 patients with necrotizing enterocolitis (NEC), 160 patients with focal intestinal perforation (FIP), 46 patients with meconium-related ileus (MRI), 77 patients with meconium peritonitis (MP), and 57 patients with other conditions. The total mortality rate was 20.5 %. The mortality rates of the patients with GR, IA, ML, NEC, FIP, MRI, and MP were 9.5, 9.1, 0, 33.1, 20.6, 28.2, and 9.1 %, respectively. In 263 cases involving extremely low-birth-weight neonates (ELBW), 108 died (mortality rate 41.1 %). The mortality rates for ELBW with GR, NEC, FIP, MRI, MP, and other conditions were 27.3 % (3/11), 58.5 % (48/82), 21.6 % (24/111), 70.6 % (24/34), 57.1 % (4/7), and 27.8 % (5/18), respectively. CONCLUSIONS: The mortality rates for ELBW decreased from 62.8 % in the previous survey to 41.1 % by the time of this survey.

A novel technique of catheter placement with fibrin glue to prevent pericatheter leakage and to enable no break-in period in peritoneal dialysis.

OBJECTIVE: Pericatheter leakage is a catheter-related complication of peritoneal dialysis (PD). To prevent pericatheter leakage, a modified technique of PD catheter insertion with fibrin glue was performed in 19 children. METHODS: At the time of PD catheter insertion, as much fibrin glue as possible was injected into the subcutaneous tissue along the tunneled segment of the catheter and then the skin was compressed. RESULTS: There was no occurrence of pericatheter leakage and full PD could be initiated 1 day (median) after implantation. CONCLUSIONS: This technique prevented pericatheter leakage completely even in smaller-weight infants and will enable initiation of full PD with no break-in period.

[The diagnostic performance of color Doppler ultrasonography for newborn four cases of midgut volvulus accompanied by intestinal malrotation].

Midgut volvulus accompanied by intestinal malrotation is classified as a surgical emergency disease of the newborn, which emerges with the bilious vomiting or melena. This report presents four patients of this disease in our hospital, evaluated by color Doppler ultrasonography before surgical operation. All four patients were presented by bilious vomiting at the onset. By color Doppler ultrasonography method, the whirlpool sign which is the view of intestine and superior mesenteric vein rotated around with the axis of superior mesenteric artery, were shown in all cases. This whirlpool sign led to the diagnosis of midgut volvulus accompanied by intestinal malrotation. Intestinal contrast imaging was tested in three patients for the purpose of confirming the diagnosis. Repair of the volvulus and a ladd operation was performed in all four patients, without the excision of intestine because of no intestinal ischemic change. The clinical courses of four cases were good, and all patients were discharged within 17 days. Early diagnosis and timely surgical operation are essential for decreasing the possibility of occurring intestinal ischemic changes and improving clinical outcome after surgical operation. We propose that color Doppler ultrasonography is the powerful tool for the diagnosis of this disease, especially for the newborn, for whom the available diagnostic tests are limited.

Innominate artery transection for patients with severe chest deformity: optimal indication and timing.

PURPOSE: The innominate artery sometimes compresses the trachea, leading to tracheomalacia and highly fatal tracheoinnominate fistula in patients with severe chest deformity. This study is focused on the indication of innominate artery transection for the definitive treatment of these complications. PATIENTS AND METHODS: We retrospectively analyzed the medical records of eight patients who underwent transection of innominate artery. RESULTS: All patients had developed severe chest deformity and their symptoms were life-threatening anoxic spell or endotracheal hemorrhage. Bronchoscopy showed tracheomalacia with or without pulsatile granulations on the anterior wall of the trachea underlying the innominate artery. In six cases who had previously undergone tracheostomy or laryngotracheal separation, the tracheal tube tip made granulations or tracheoinnominate fistulas. In addition to transection of innominate artery, the tracheoinnominate fistula was closed in two cases and the artery was transposed in one. All patients survived without neurologic complications and airway symptoms postoperatively. CONCLUSIONS: For patients with severe chest deformity, innominate artery transection is indicated when they have tracheal compression by the artery and need to be intubated through the compressed part of trachea to secure the airway. This would be the best timing to schedule the prophylactic operation.

A very low-birth-weight infant with spontaneous perforation of a choledochal cyst and adjacent pseudocyst formation.

Spontaneous perforation of a choledochal cyst with ensuing pseudocyst formation is a very rare complication. We report the development of a pseudocyst adjacent to a choledochal cyst in a very low-birth-weight infant at 2 months of age. Elective excision of the choledochal cyst and biliary tract reconstruction were successfully performed 2 months later when the infant weighed 3 kg. Delayed primary repair may be a viable alternative treatment for low-birth-weight infants with choledochal cysts.

Hypoalbuminemia following abdominal surgery leads to high serum unbound bilirubin concentrations in newborns soon after birth.

BACKGROUND: The serum concentration of unbound bilirubin (UB), which is bilirubin not bound to albumin (Alb), is a better index than total bilirubin concentration (TB) for identifying infants at risk for developing bilirubin neurotoxicity. The degree to which the hypoalbuminemia following abdominal surgery in jaundiced newborns affects bilirubin binding is unknown. OBJECTIVE: To determine whether lower Alb occurring in newborns undergoing abdominal surgery shortly after birth results in significantly higher UB in serum versus nonsurgical patients at comparable serum TB. METHODS: A matched case-control study was conducted with term and late-preterm newborns. The surgery group included 15 newborns who underwent abdominal operation within 3 days after birth. Clinical and laboratory data (serum UB, TB, and Alb concentrations, UB/TB ratio, and binding constant) in the surgery group were collected and compared with those of 30 control newborns who did not undergo abdominal surgery (control group). RESULTS: Serum UB and the UB/TB ratio in the surgery group were significantly higher than those in the control group (p < 0.02, p < 0.001, respectively), whereas there were no significant differences in serum TB and binding constant between the groups. Serum Alb concentrations in the surgery group were significantly lower than those in the control group (p < 0.001). When pre- and postoperative serum Alb concentrations were compared, there was a significant decrease from 3.4 to 2.7 g/dl (p < 0.001). CONCLUSIONS: Our study suggests that hypoalbuminemia following abdominal surgery causes a higher serum UB at comparable serum TB in newborns.

Efficacy and safety of balloon-occluded retrograde transvenous obliteration for gastric fundal varices in children.

Balloon-occluded retrograde transvenous obliteration (B-RTO) is an interventional radiologic technique that obliterates gastric fundal varices (GFV) from draining veins under balloon occlusion. Few reports have described the use of B-RTO in children. Here, we report a case of B-RTO in a 2-year-old female patient with isolated huge varices in the gastric fundus associated with portal hypertension after surgery for biliary atresia. There was no complication and thrombosis of the varices was achieved. Our results demonstrate that B-RTO is an efficacious and safe treatment for children with isolated GFV.

Bronchopulmonary foregut malformation: a large bronchogenic cyst communicating with an esophageal duplication cyst.

A 1-year-old boy with a bronchopulmonary foregut malformation presented with a large mediastinal bronchogenic cyst associated with pulmonary sequestration, a cervical esophageal duplication cyst, a bronchial communication between these cysts, and 2 small bronchogenic cysts around the communication. These lesions were resected followed by an uneventful recovery.