Evaluation of prognostic factors in neonatal intestinal obstruction.

Karthik, S Bhandary (2010) Evaluation of prognostic factors in neonatal intestinal obstruction. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION : Neonatal surgical emergencies cause considerable mortality and morbidity with intestinal obstruction being a common cause. The etiology ranges from Duodenal / Jejunal atresias to Malrotation, Annular pancreas, duplication cyst, volvulous, meconium ileus, pyloric stenosis, Hirschsprungs disease to anorectal anomalies. The mode of presentation can be acute or more chronic with systemic upset due to shock. Neonates, more so than older children, with unrecognized intestinal obstruction deteriorate rapidly, show an increase of associated morbidity and mortality. Early diagnosis depends largely on the prompt detection of Obstructive manifestations and the subsequent accurate interpretation of radiographic findings and other investigations, leading to surgical treatment, which should always be preceded by appropriate resuscitation/ preparation of the neonate. With the advent of neonatal intensive care the prognosis is mainly determined by the coexistence of other major congenital anomalies (eg, cardiac, respiratory, renal), delays in referral or coexisting factors as prematurity ,sepsis, low birth weight, respiratory distress ,operative procedure/ time. This study focuses on etiology, clnical presentation, and operative details and follow up with emphasis on the good and poor prognostic factors affecting the outcome. AIMS : 1. To know the frequency, mode of presentation of the various causes of neonatal intestinal obstruction. 2. To identify the good and poor prognostic factors associated with neonatal intestinal obstruction. 3. To evaluate the various surgical interventions and their outcome. 4. To analyse the relationship between the prognostic factors and outcome post operatively. MATERIALS AND METHODS : Study Design – Retrospective and prospective study evaluating the prognostic factors in neonatal intestinal obstruction. Study Period : December 2004 – December 2009. Study Centre : Department of Paediatric Surgery, Coimbatore Medical College Hospital. INCLUSION CRITERIA - 1. Newborn less than 28 days old. 2. Presenting clinically with vomiting, abdominal distension, failure to pass meconium. EXCLUSION CRITERIA - 1. Babies older than 28 days. 2. Babies diagnosed as cases of Hirschsprungs, Anorectal anomaly, Esophageal atresia. CONCLUSION : 1. Jejunoileal atresias are the commonest cause of neonatal intestinal obstruction. 2. Bilious Vomiting is the cardinal and thecommonest presenting symptom. The next commonest symptom is abdominal distension, followed by failure of passage of meconium seen more in case of distal atresias. Early suspecion is necessary to prevent the morbidity due to late referral. 3. Prenatal Ultrasound diagnosis provides the opportunity for appropriate counseling and for planning the delivery in a tertiary care center with a pediatric surgeon and a neonatal intensive care unit. 4. Low birth weight and prematurity are significant bad prognostic factors associated with considerable early post operative mortality. 5. Complex cardiac defects which pose a high anaesthetic risk is a negative prognostic factor. 6. Longer operative time which indicates complex procedures with adhesiolysis, gross contamination of the abdomen and gangrenous bowel are associated with increased morbidity and mortality signifying their prognostic value. 7. Reoperations and Postoperative sepsis are associated with poorer outcome. 8. Neonates with birth weight >2.5 kgs, term babies, early referrals all add up to the early recovery with minimum length of hospital stay and are of good prognostic value. 9. Surgical interventions per say though not based on the operative findings had major prognostic value shorter surgical endeavours as pyloromyotomy and clean procedures carry good prognosis in contrary to adhesiolysis, tapering enteroplasties and diversion procedures.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Neonatal intestinal obstruction ; prognostic factors ; Evaluation.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 31 Jul 2017 04:31
Last Modified: 31 Jul 2017 09:24
URI: http://repository-tnmgrmu.ac.in/id/eprint/2367

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