Portal venous gas and surgical outcome of neonatal necrotizing enterocolitis
Section snippets
Materials and methods
From October 1991 to February 2003, we prospectively identified all infants with NEC (Bell stage II or higher) [5]. We excluded infants with birth weights (BWs) 400 g or less, infants with major congenital or chromosomal abnormalities, and infants with recurrent episodes of NEC. Evaluations performed at the onset of illness included abdominal radiographs, complete blood cell count, blood culture, arterial blood gas, and serum electrolytes. Fecal specimens were tested for bacteria, Clostridium
Results
A total of 194 infants met the diagnostic criteria for NEC and was included in the study (Fig. 1). The overall incidence of NEC was 3.7%. Portal venous gas was identified in 64 (33%) of the 194 infants with NEC. Sixty-two (97%) of the infants with PVG had been receiving partial or total enteral feeds. Two infants manifested PVG within the first few hours of life without having received enteral nutrition. Both infants had been born prematurely (at 24 and at 34 weeks) to mothers with
Discussion
Portal venous gas in neonatal NEC was first described by Wolfe and Evans [9] in 1955. The preponderance of PVG in infants with severe IMG in our study population supports the contention that PVG is an extension of IMG in neonatal NEC [1], [3]. The origin of IMG and PVG is the fermentation of substrates in milk feedings by bacteria present in the gastrointestinal lumen [10]. Hydrogen and methane are the predominant components of IMG [10]. The presence of PVG in an unfed infant has not been
Acknowledgments
The authors thank Carmela B. Monteiro, MD, Associate Professor, Department of Pathology, for examination of specimens. The authors thank Savithri Raja, BSc (student), King's College, University of London, for data entry; Pam Pieper, ARNP, Pediatric Surgery, Department of Surgery, and Patricia A. Williams, ARNP, Division of Neonatology, for data collection; and the nursing staff with all neonatal nurse practitioners of Shands Jacksonville for their cooperation with this project.
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