- Email: [email protected]
Intermittent peritoneal lavage after diffuse peritonitis in newborns and infants
878
INTERNATIONAL ABSTRACTS
at 5 years of age was not higher in those who had previously experienced one or more episodes of cholangitis.--George Holcomb, Jr Intermittent Peritoneal Lavage After Diffuse Peritonitis in Newborns and Infants. K. Heller and K.-L. Waag. Z Kinderchir 42:241-
245, (August), 1987. Between 1981 and 1985, 15 neonates with severe putrid or fecal peritonitis due to intestinal perforation were treated by intermittent postoperative peritoneal lavage. During laparotomy, two to four drainage tubes were inserted into the peritoneal cavity. Immediately after operation, peritoneal lavage was started with 20 mL/kg of Ringer or peritoneal dialysis solution. Inflow of the solution was done during a 20-minute period. The solution remained in the peritoneal cavity for another 20 minutes and was withdrawn over 20 minutes. Antibiotics or antiseptics were not used in addition to the saline fluid in order to prevent tissue damage or bowel adhesions. Accurate documentation of inflow and outflow balance is important. The authors recommend intermittent peritoneal lavage in the postoperative management of newborns with severe peritonitis due to intestinal perforation to improve the poor prognosis. Ten of the patients in this series survived.--Thomas A. Angerpointner The Microbiology of Neonatal Peritonitis. E.L. Motlitt, J.J. Tepas III, andJ.L. Talbert. Arch Surg 123:176-179, (February), 1988.
Eighty-six newborns who underwent surgery for necrotizing enterocolitis (NEC) were reviewed to determine the type and incidence of microorganisms recovered. The number of organisms isolated per patient was 1.7. Although enteric gram-negative bacilli were recovered in 80% of newborns, the incidence of Escherichia coli was only 21%, while Klebsiella and Enterbacter species represented the most common gram-negative isolates recovered. More than 50% of neonatal cultures yielded gram-positive cocci, most frequently coagulase-negative cocci and enterococci. In only 6% of NEC cases were anaerobes cultured. Also, Candida isolates were recovered in 10% of NEC cases. These results indicate a peculiar bacteriology of peritonitis in the critical infant.--George A. Rowe Surgical Options in the Management of Large Omphaloceles. E.L
Hatch and R.B. Baxter. Am J Surg 153:449-452, (May), 1987. Infants with omphalocele seen over 10 years were divided retrospectively into four groups. There were 23 neonates in group 1 whose defect in the abdominal wall was <7 cm and who underwent primary fascial closure. Group 2 contained 13 neonates with defects ranging from 4 to 10 cm and who uniformly had liver contained within the defect. Primary closure was judged to be unsafe in these patients, and therefore, silon chimneys were placed. While each of the Group 1 patients had a satisfactory outcome, in group 2 there were six postoperative deaths (46%). Two of the six patients and major cardiovascular abnormalities. Two cases of giant omphalocele were managed nonoperatively (group 3). Fascial closure was effected at nine months of age. An additional 15 infants were thought to have associated conditions so serious as to preclude surgery (group 4). The overall mortality for the infants in group 1 to 3 was 13%.--Thomas V. Whalen GENITOURINARY TRACT Orchidopexy: The Effect of Changing Patterns of Referral and Treatment on Outcome. N.J.M. London, H.T. Joseph, and J.M.S.
Johnstone. Br J Surg 74:636-638, (July), 1987. One hundred twenty-eight orchidopexies performed between 1979 and 1981 were reviewed in 1985. Also reviewed were the results of operations performed in 1972. The age of referral has been deter-
mined for 1972, 1979 to 1981, and 1985. The number of unsatisfactory results has decreased from 35% in 1972 to 9.4% between 1979 and 1981. Five cases of the "ascending testicle" were discovered, confirming the importance of this phenomenon. The optimum age for orchidopexy is during the second year of life. However, during 1985, only 20% of boys referred for orchidopexy were <3 years of age. Doctors performing neonatal examinations should consider the possibility of cryptorchidism and ensure that affected neonates are reviewed at 1 year of age. The potential theoretical advantages of orchidopexy at an early age will be converted into clinical benefit only if the operation is performed by an experienced surgeon who has developed an expertise in this area of surgery.--Lewis Spitz Undescended Testes in Low Birth Weight Infants. R. Morley and
A. Lucas. Br Med J 295:753, (September), 1987. The incidence of cryptorchidism in boys born at term is reported to be around 2%. The condition is well-known to be common in preterm infants. This report records the incidence of incomplete testicular descent in 355 male infants with a birth weight of under 1,850 g, born between 1982 and 1983. The overall incidence was 35/355 (9.9%) with a close correlation with birth weight, increasing from 4% in infants between 1,600 and 1,849 g to 19% in infants under 1,000 g. Bilateral cryptorchidism was present in 43% of low birth weight infants compared with 10% to 25% in term infants. Babies born after 32 weeks of gestation had a normal incidence of cryptorchidism--about 2%. Also associated with crytoporchidism were development of necrotizing enterocolitis P = .025 and eczema P = .001. There was a possible association with maternal steroid treatment P = .053. This confirms the clearly established clinical impression, but puts it on a sound statistical basis.--J.A.S. Dickson Acute Idiopathic Scrotal Oedema: Incidence, Manifestations and
Aetiology..4. Najmaldin and D.M. Burge. Br J Surg 74:634-635, (July), 1987. Twenty-four children with a total of 31 episodes of acute idiopathic scrotal oedema (ALSO) were assessed during a 5-year period. AISO accounted for 30% of all admissions with acute scrotal pathology in this period, and was the final diagnosis in 69% of cases in those presenting under the age of 10 years. Although presentation was with unilateral (48%) or bilateral (52%) AISO, considerable overlap between these two groups occurred. Five patients (21%) had recurrent attacks. Fourteen boys (60%) had a history of allergy or had allergic manifestations at presentation compared with an incidence of allergy of 28% in 42 controls (P < .05). AISO is the most common cause of the "acute scrotum" in boys under 10 years of age and is probably allergic in origin.--Lewis Spitz The Prophylactic Use of Clean Intermittent Catheterization in the Treatment of Infants and Young Children With Myelomeningocele and Naurogenic Bladder Dysfunction. E. Geraniotis, S.A. Koff, and
B. Enrile. J Urol 139:85-86, (January), 1988. To examine the hypothesis that the prophylactic use of clean intermittent catheterization can prevent urinary tract deterioration in infants and young children with myelomeningocele, a prospective controlled study was performed on 24 patients. Preliminary results indicate that more than 50% of the patients with bladder sphincter incoordination managed by self-voiding had urinary tract deterioration. In contrast, in only 10% of the patients treated prophylactically with clean intermittent catheterization did deterioration occur. It is concluded that when bladder sphincter incoordination is diagnosed in children with myelomeningocele, they are at a high risk for the development of future urinary tract injury. The prophylactic use of clean intermittent catheterization can actually prevent this deterio-
INTERNATIONAL ABSTRACTS
at 5 years of age was not higher in those who had previously experienced one or more episodes of cholangitis.--George Holcomb, Jr Intermittent Peritoneal Lavage After Diffuse Peritonitis in Newborns and Infants. K. Heller and K.-L. Waag. Z Kinderchir 42:241-
245, (August), 1987. Between 1981 and 1985, 15 neonates with severe putrid or fecal peritonitis due to intestinal perforation were treated by intermittent postoperative peritoneal lavage. During laparotomy, two to four drainage tubes were inserted into the peritoneal cavity. Immediately after operation, peritoneal lavage was started with 20 mL/kg of Ringer or peritoneal dialysis solution. Inflow of the solution was done during a 20-minute period. The solution remained in the peritoneal cavity for another 20 minutes and was withdrawn over 20 minutes. Antibiotics or antiseptics were not used in addition to the saline fluid in order to prevent tissue damage or bowel adhesions. Accurate documentation of inflow and outflow balance is important. The authors recommend intermittent peritoneal lavage in the postoperative management of newborns with severe peritonitis due to intestinal perforation to improve the poor prognosis. Ten of the patients in this series survived.--Thomas A. Angerpointner The Microbiology of Neonatal Peritonitis. E.L. Motlitt, J.J. Tepas III, andJ.L. Talbert. Arch Surg 123:176-179, (February), 1988.
Eighty-six newborns who underwent surgery for necrotizing enterocolitis (NEC) were reviewed to determine the type and incidence of microorganisms recovered. The number of organisms isolated per patient was 1.7. Although enteric gram-negative bacilli were recovered in 80% of newborns, the incidence of Escherichia coli was only 21%, while Klebsiella and Enterbacter species represented the most common gram-negative isolates recovered. More than 50% of neonatal cultures yielded gram-positive cocci, most frequently coagulase-negative cocci and enterococci. In only 6% of NEC cases were anaerobes cultured. Also, Candida isolates were recovered in 10% of NEC cases. These results indicate a peculiar bacteriology of peritonitis in the critical infant.--George A. Rowe Surgical Options in the Management of Large Omphaloceles. E.L
Hatch and R.B. Baxter. Am J Surg 153:449-452, (May), 1987. Infants with omphalocele seen over 10 years were divided retrospectively into four groups. There were 23 neonates in group 1 whose defect in the abdominal wall was <7 cm and who underwent primary fascial closure. Group 2 contained 13 neonates with defects ranging from 4 to 10 cm and who uniformly had liver contained within the defect. Primary closure was judged to be unsafe in these patients, and therefore, silon chimneys were placed. While each of the Group 1 patients had a satisfactory outcome, in group 2 there were six postoperative deaths (46%). Two of the six patients and major cardiovascular abnormalities. Two cases of giant omphalocele were managed nonoperatively (group 3). Fascial closure was effected at nine months of age. An additional 15 infants were thought to have associated conditions so serious as to preclude surgery (group 4). The overall mortality for the infants in group 1 to 3 was 13%.--Thomas V. Whalen GENITOURINARY TRACT Orchidopexy: The Effect of Changing Patterns of Referral and Treatment on Outcome. N.J.M. London, H.T. Joseph, and J.M.S.
Johnstone. Br J Surg 74:636-638, (July), 1987. One hundred twenty-eight orchidopexies performed between 1979 and 1981 were reviewed in 1985. Also reviewed were the results of operations performed in 1972. The age of referral has been deter-
mined for 1972, 1979 to 1981, and 1985. The number of unsatisfactory results has decreased from 35% in 1972 to 9.4% between 1979 and 1981. Five cases of the "ascending testicle" were discovered, confirming the importance of this phenomenon. The optimum age for orchidopexy is during the second year of life. However, during 1985, only 20% of boys referred for orchidopexy were <3 years of age. Doctors performing neonatal examinations should consider the possibility of cryptorchidism and ensure that affected neonates are reviewed at 1 year of age. The potential theoretical advantages of orchidopexy at an early age will be converted into clinical benefit only if the operation is performed by an experienced surgeon who has developed an expertise in this area of surgery.--Lewis Spitz Undescended Testes in Low Birth Weight Infants. R. Morley and
A. Lucas. Br Med J 295:753, (September), 1987. The incidence of cryptorchidism in boys born at term is reported to be around 2%. The condition is well-known to be common in preterm infants. This report records the incidence of incomplete testicular descent in 355 male infants with a birth weight of under 1,850 g, born between 1982 and 1983. The overall incidence was 35/355 (9.9%) with a close correlation with birth weight, increasing from 4% in infants between 1,600 and 1,849 g to 19% in infants under 1,000 g. Bilateral cryptorchidism was present in 43% of low birth weight infants compared with 10% to 25% in term infants. Babies born after 32 weeks of gestation had a normal incidence of cryptorchidism--about 2%. Also associated with crytoporchidism were development of necrotizing enterocolitis P = .025 and eczema P = .001. There was a possible association with maternal steroid treatment P = .053. This confirms the clearly established clinical impression, but puts it on a sound statistical basis.--J.A.S. Dickson Acute Idiopathic Scrotal Oedema: Incidence, Manifestations and
Aetiology..4. Najmaldin and D.M. Burge. Br J Surg 74:634-635, (July), 1987. Twenty-four children with a total of 31 episodes of acute idiopathic scrotal oedema (ALSO) were assessed during a 5-year period. AISO accounted for 30% of all admissions with acute scrotal pathology in this period, and was the final diagnosis in 69% of cases in those presenting under the age of 10 years. Although presentation was with unilateral (48%) or bilateral (52%) AISO, considerable overlap between these two groups occurred. Five patients (21%) had recurrent attacks. Fourteen boys (60%) had a history of allergy or had allergic manifestations at presentation compared with an incidence of allergy of 28% in 42 controls (P < .05). AISO is the most common cause of the "acute scrotum" in boys under 10 years of age and is probably allergic in origin.--Lewis Spitz The Prophylactic Use of Clean Intermittent Catheterization in the Treatment of Infants and Young Children With Myelomeningocele and Naurogenic Bladder Dysfunction. E. Geraniotis, S.A. Koff, and
B. Enrile. J Urol 139:85-86, (January), 1988. To examine the hypothesis that the prophylactic use of clean intermittent catheterization can prevent urinary tract deterioration in infants and young children with myelomeningocele, a prospective controlled study was performed on 24 patients. Preliminary results indicate that more than 50% of the patients with bladder sphincter incoordination managed by self-voiding had urinary tract deterioration. In contrast, in only 10% of the patients treated prophylactically with clean intermittent catheterization did deterioration occur. It is concluded that when bladder sphincter incoordination is diagnosed in children with myelomeningocele, they are at a high risk for the development of future urinary tract injury. The prophylactic use of clean intermittent catheterization can actually prevent this deterio-