Portal venous air: The poor prognosis persists*
Section snippets
Materials and methods
A retrospective analysis of all infants with NEC that presented with or in whom portal venous air developed between 1995 and 1999 (n = 40) at the James Whitcomb Riley Hospital for Children, Indianapolis, IN was performed. Parameters evaluated included gestational age, birth weight, need for intubation, onset of symptoms, radiographic findings, feeding intolerance, bloody stools, metabolic acidosis, need for hemodynamic support, and outcome. Patients who underwent operative intervention were
Results
The average gestational age was 26 weeks (range, 23 to 41 weeks) and average birth weight 1,173 g (range, 650 to 3,300 g). Twenty-one infants (52%) weighed less than 1,000 g. Before the development of NEC, 23 infants (57.5%) were tolerating full feedings and 8 (20%) partial feedings. All 40 infants required endotracheal intubation at birth, and 23 (57.5%) required reintubation at the onset of PVA. In all cases, PVA was present within 24 hrs of onset of abdominal distension, feeding intolerance,
Discussion
NEC continues to be a common problem particularly in premature infants of low birth weight. Although this condition affects nearly 2% of all infants admitted to the NICU, the incidence increases to nearly 10% among very low birth weight babies (< 1,000 g).2, 4, 5 With improvements in the management of hyaline membrane disease and other comorbidities, the overall survival rate of infants who have NEC has improved.6 The mortality rate of infants with NEC who require surgical intervention has
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2017, Avery's Diseases of the Newborn, Tenth Edition
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Address reprint requests to Karen W. West, MD, JW Riley Hospital for Children, 702 Barnhill Dr, Suite 2500, Indianapolis, IN 46202-5200.