Helios Klinikum Duisburg, Germany
Title: Severe Metabolic Acidosis and Hypercapnia Predict Major Bowel Resection in (Preterm) Infants with Surgical Abdomen
Ralf-Bodo Troebs has special interests in neonatal pediatric surgery, esophageal and bowel atresia, bowel problems of the neonate, pyloric stenosis, and perioperative physiology. Formerly he was the head of the Department of Pediatric Surgery, Ruhr-University of Bochum, Sankt Elisabeth Group, Herne, Witten, Germany (data source).
Surgery of preterm and newborn infants with acute abdomen is one of the most serious problems in pediatric surgery. The aim of the presented study is to find out the predictive value of preoperative acid-base analysis [ABA] for bowel involvement. Material: A total of 211 subsequent neonatal cases with acute surgical abdomen was operated between 2012 and 2018. 137 infants fulfilled the inclusion criteria and had a complete data set. Postnatal age at surgery varied between 0 and 91 days (median 8 days); body weight was between 415 and 4730 g (median 1555 g). Predominating diagnoses were necrotizing enterocolitis (n=48), small bowel atresia (n=36), meconium obstruction syndromes (n=21), volvulus (n=10) and miscellaneous. The extend of bowel affection was classified according to the length of resected bowel, and/or presence of subtotal NEC: no or moderate (less than 10 cm), major (10 – 34 cm), and extended/subtotal (> 34 cm and/or resection of the ileocoecal valve). For estimation of the resected length primary operation and subsequent laparotomies were taken into account. Data Source: Sankt Elisabeth Group, Marienhospital Herne. Results. Major resections were required in 26 infants, and extended resections in 26 infants (n=52, 38 %). The overall mortality was 9.5% (n=13). We found a good relationship between the degree of metabolic acidosis (pH, BE, lactate), subsequent respiratory de-arrangement (pCO2), and the extend of bowel resection (Table). In contrast to severe acidosis, all infants with alkalosis (pH≥7.45) survived. Conclusion. Surgery of this delicate group of infants was associated with high percentage of mortality and long-term sequel. Preoperative blood gas analysis gives important information regarding the degree of illness and the expected length of destroyed bowel. Severe metabolic acidosis and elevated pCO2, indicate a high risk for loss of relevant bowel length. Alkalosis indicated a more benign course.