Role of Nutrition in Prevention of Neonatal Spontaneous Intestinal Perforation and Its Complications: A Systematic Review.

BACKGROUND: Spontaneous intestinal perforation (SIP) is a devastating complication of prematurity, and extremely low birthweight (ELBW < 1000 g) infants born prior to 28 weeks are at highest risk. The role of nutrition and feeding practices in prevention and complications of SIP is unclear. The purpose of this review is to compile evidence to support early nutrition initiation in infants at risk for and after surgery for SIP. Methods: A search of PubMed, EMBASE and Medline was performed using relevant search terms according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Abstracts and full texts were reviewed by co-first authors. Studies with infants diagnosed with SIP that included information on nutrition/feeding practices prior to SIP and post-operatively were included. Primary outcome was time to first feed. Secondary outcomes were incidence of SIP, time to full enteral feeds, duration of parenteral nutrition, length of stay, neurodevelopmental outcomes and mortality. Results: Nineteen articles met inclusion criteria-nine studies included feeding/nutrition data prior to SIP and ten studies included data on post-operative nutrition. Two case series, one cohort study and sixteen historical control studies were included. Three studies showed reduced incidence of SIP with initiation of enteral nutrition in the first three days of life. Two studies showed reduced mortality and neurodevelopmental impairment in infants with early feeding. Conclusions: Available data suggest that early enteral nutrition in ELBW infants reduces incidence of SIP without increased mortality.

The relation between the location and the perforation rate of lung hydatid cysts in children.

BACKGROUND/OBJECTIVE: The pressure, size, and central or peripheral location of lung hydatid cysts are the most studied topics among the factors affecting perforation. The aim of this study is to investigate the relation between the location and the perforation rate of lung hydatid cysts in children. METHODS: 197 patients under the age of 16 years, who were operated between January 2000 and December 2016 due to pulmonary hydatid cysts, were evaluated retrospectively. Patients who had giant hydatid cysts (n = 27), bilateral hydatid cysts (n = 24), and more than one cyst in one lung (n = 12) were excluded to create a more homogeneous group to enable investigation of the relation between the location and the perforation rates of hydatid cysts. Finally, 134 patients who had only one hydatid cyst were classified into two groups: Group 1 with perforated cysts and Group 2 with intact hydatid cysts. RESULTS: 70.9% of the patients were male. In total, 134 cysts were detected and 41% were perforated. The highest perforation rates were detected in the right middle lobe (70%) and the lingula (66.7%). There was a statistically significant difference between the location of the cysts and the perforation rates (p = 0.018). Also hydatid cysts located in the right middle lobe and the lingula had higher postoperative complication rates than hydatid cysts located in the upper and lower lobes (p = 0.018). CONCLUSION: We recommend surgical treatment as soon as possible in children with hydatid cysts located in the right middle lobe and lingula to prevent the risk of perforation.