Diagnosis and methods of correction of organ dysfunction in newborns with perforation peritonitis

Abstract

Introduction: necrotic enterocolitis and stomach perforation belong to pressing issues of neonatal surgery and intense therapy. A set of clinical and laboratory values can be interpreted subjectively due to polyetiology of necrotic enterocolitis and stomach perforation. Indications and surgical management of perforation peritonitis in newborns are still contradictory. Purpose: diagnostics objectivization, treatment of perforation peritonitis and organ dysfunction in necrotic enterocolitis, intestinal and stomach perforation in newborns. Materials and methods: a retrospective, observational, cohort study with 46 5–14-days-old newborns (2007–2017). Inclusion criteria: clinical symptoms of necrotic enterocolitis (Bell (1978) modified by Kliegman (1986)), pneumoperitoneum in stomach perforation. Shock syndrome gradation was done based on FEAST (Fluid Expansion as Supportive therapy) (2017) criteria, while organ failure was evaluated using pSOFA (Pediatric Sequential (Sepsis-related) Organ Failure Assessment) score (2017) with lethality prediction (Vincent J. L., 1998). Statistical analysis uses descriptive statistics and non-parametric Mann-Whitney U test (P<0.05). Results: specific diagnostic criteria of perforation peritonitis such as intestinal pneumatosis, multiple levels of air/ liquid, pneumoperitoneum were distinguished, whereas dysfunction of GIT and respiratory system were the principal links of multiple organ dysfunction. Conclusion: midline laparotomy is a basic method of surgical treatment at institutions providing III level medical aid. In newborns with perforation peritonitis, restrictive strategy of GIT dysfunction intensive treatment based on ESICM (2012) recommendations decreased a short-term lethality to 6.3%.

Keywords

criteria / necrotic enterocolitis / stomach perforation / intensive therapy / surgery / newborn

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RIGHTS & PERMISSIONS

Anastasov A.G., Schierbinin A.V.