Surgery News - February 2008 - (Page 15)

F E B R U A RY 2 0 0 7 • SURGERY NEWS PEDIATRIC 15 Long-Term Follow-Up Reveals Morbidities in NEC Patients BY BRUCE JANCIN Else vier Global Medical Ne ws C O L O R A D O S P R I N G S — Bowel function was normal in up to 90% of patients 15-35 years after treatment for neonatal necrotizing enterocolitis in a large singlecenter series, but neurologic and respiratory complications were common, Dr. Thomas R. Weber said at the annual meeting of the Western Surgical Association. The high prevalence of chronic neurologic and respiratory problems was “probably the most disturbing finding in the study,” he said, adding that blindness, deafness, and severe cerebral palsy resulted in some cases. The incidence of neonatal necrotizing enterocolitis (NEC) has climbed in recent decades in tandem with improved survival following premature birth. Its etiology is multifactorial and poorly understood. Although today NEC is successfully managed nonoperatively in 50%-60% of cases with a combination of bowel rest, antibiotics, and ventilator support, the condition nonetheless remains a common pediatric surgical emergency, said Dr. Weber, who is an ACS Fellow, professor of surgery and head of the division of pediatric surgery at Albany (N.Y.) Medical College, and surgeon-in-chief at Children’s Hospital of Albany. Of the 255 patients with NEC who were treated operatively and 180 who were managed nonoperatively at Children’s Hospital during 1970-1990, Dr. Weber and his coinvestigators were able to locate and survey 63% of the patients or their families. He hypothesized that overall survival as well as long-term bowel, respiratory, and neurologic outcomes would be better among patients treated in the 1980s than the 1970s because of advances in patient management. But overall survival was 97% at follow-up among patients who were managed operatively and 88% in those who were treated nonoperatively during the 1970s, and 91% and 85%, respectively, during the 1980s—statistically similar results. In the subset of children with NEC and a birth weight below 1,000 g, survival at follow-up was 60%-75%. “There’s a significant increase in morbidity, too. Many of these infants had chronic respiratory and/or neurologic morbidity,” he said. Roughly 90% of operatively managed patients and three-quarters of those managed nonoperatively were on a regular diet at follow-up, regardless of when they were treated. A normal bowel habit was reported by 84%-90% of patients. Nearly one-quarter of patients whose NEC was managed operatively underwent additional abdominal surgery later in life. Neurologic deficits were present at follow-up in 25%-32% of patients, with no significant differences between groups or time periods. Respiratory morbidity was present in 39%-50% of patients at 15- to 35-year follow-up. One in five patients with NEC had short bowel syndrome. Morbidity and mortality in this subgroup were particularly high, notably because of liver failure. Dr. Weber was surprised at how little un- derstanding many patients and their families had about the past life-threatening condition. “A number of patients knew they had a scar on their abdomen but had no idea what that scar was there for,” he said. Discussant Dr. Karen W. West commented that multiple studies indicate that babies requiring care in a neonatal ICU have as much as a one-in-three chance of ending up with permanent physical, psychological, or developmental handicaps. “It appears the morbidities in this group mainly relate to the respiratory strategies we’ve employed. It can be hoped that a series of patients from 1990 and beyond— with the initiation of our gentle ventilation techniques, tolerance of lower endotracheal pressures, and lower arterial oxygen saturation levels—may actually reduce the number of patients with visual losses and chronic lung disease,” said Dr. West, an ACS Fellow and pediatric surgeon at Indiana University, Indianapolis. The Albany study, with more than one in three patients lost to follow-up, underscores the difficulty in conducting decades-long follow-up studies in pediatric patients, she said. The study demonstrates “the disappointing finding of fixed and consistent outcomes for NEC across decades—despite the theoretic improvements across ventilator or other technologies coincident with the growth of a specialty focus in neonatology,” said Dr. Thomas Tracy, an ACS Fellow and pediatric surgeon in chief at Hasbro Children’s Hospital (Providence, R.I.), who commented on the study. ■ SAVE THE DATES! THE AMERICAN COLLEGE OF SURGEONS AT THE SOUTHEASTERN SURGICAL CONGRESS SUNDAY, FEBRUARY 10, 2008 2:00 –5:45 PM Panel: What’s New at the ACS Panel: What Practicing Surgeons Need to Know About Maintenance of Certiﬁcation and How the American College of Surgeons Can Help Presenters: L. D. Britt, MD, MPH, FACS; Edward M. Copeland III, MD, FACS; Josef E. Fischer, MD, FACS; Thomas R. Russell, MD, FACS; Ajit K. Sachdeva, MD, FACS, FRCSC; and Steven C. Stain, MD, FACS THE AMERICAN COLLEGE OF SURGEONS AT THE SOUTHWESTERN SURGICAL CONGRESS MONDAY, MARCH 31, 2008 8:00 AM–12:00 NOON Panel: What’s New at the ACS Panel: What Practicing Surgeons Need to Know About Maintenance of Certiﬁcation and How the American College of Surgeons Can Help Presenters: Barbara L. Bass, MD, FACS; L. D. Britt, MD, MPH, FACS; Josef E. Fischer, MD, FACS; Gerald B. Healy, MD, FACS; Russell G. Postier, MD, FACS; Thomas R. Russell, MD, FACS; Ajit K. Sachdeva, MD, FACS, FRCSC; and Alan G. Thorson, MD, FACS Southeastern Surgical Congress FEBRUARY 9–12, 2008 Sheraton Birmingham Birmingham, AL visit www.sesc.org or call 800/558-8958 To register, Southwestern Surgical Congress MARCH 30–APRIL 2, 2008 Fairmont Princess Acapulco, Mexico To register, visit www.swscongress.org or call 913/402-7102 An exhibit will be presented at the time of each Surgical Congress demonstrating the new educational programs and products of ACS that are specially designed to help practicing surgeons meet MOC requirements. F O R M O R E I N F O R M AT I O N , contact Julie Tribe, MSEd, Senior Manager, Educational Programs, Division of Education, at jtribe@facs.org or 312/202-5433. FOR INFORMATION ON ACS, visit www.facs.org or call 800/621-4111. http://www.facs.org http://www.sesc.org http://www.swscongress.org http://www.sesc.org http://www.swscongress.org http://www.facs.org

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Surgery News - February 2008 Contents IOM Committee Looks Into Safety Of Work Schedules Expertise Can Extend Liver Resectability Report Faults Specialty Hospitals' EDs Meeting Expectations Silver Lining HOD on Health Longer Liver Life?

Surgery News - February 2008

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