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KMID : 1101620160270040216
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Perinatology
2016 Volume.27 No. 4 p.216 ~ p.221
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Risk Factors of Operation in Neonates with No Less Than 35 Weeks of Gestational Age with Bilious Vomiting
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Shin Jae-Seok
Lee Yong-Hee
Shim Gyu-Hong
Chey Myoung-Jae
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Abstract
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Purpose: Bilious vomiting in neonates is an urgent condition that frequently requires neonatal surgical involvement. We aimed to describe the prevalence of surgical intervention and compare clinical characteristics between neonates with and without operation.
Methods: The medical records and images were reviewed for neonates with no less than 35 weeks of gestational age who have a bilious vomiting and admitted to the neonatal intensive care unit (NICU) at Inje University Sanggye Paik Hospital from January 2010 to December 2015.
Results: Fifty neonates with bilious vomiting were analyzed whose were admitted to our NICU and not transferred during the period. Twenty-one (42%) neonates had laparotomies of which 9 were malrotations with volvulus, 6 Hirschsprung's disease, 2 duodenal atresia or stenosis, 2 small bowel obstructions, 1 neonatal necrotizing enterocolitis, and 1 meconium ileus. Gestational age was 39+2 weeks (35+0-40+6 weeks); birth weight was 3,120 g (1,885-4,650 g). There were 24 (48%) abnormal X-rays, 25 (50%) abnormal abdominal sonographies and/or contrast studies. Univariate analysis indicate that frequency of vomitus, volume of vomitus, abdominal distension, delayed passage of meconium, neonatal cholestasis, abnormal X-rays, abnormal abdominal sonographies or contrast studies were significant predictors of operation. Multivariate analysis showed that frequency of vomitus (P=0.002, odds ratio [OR] 5.7, 95% confidence interval [CI] 1.9-17.1) and abnormal abdominal sonographies or contrast studies (P=0.007, OR 22.2, 95% CI 2.3-212.1) were independent risk factors for operation.
Conclusion: Frequency of vomitus and abnormal abdominal sonographies or contrast studies in neonates with bilious vomiting may be the most important indicator to predict the need for surgery.
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KEYWORD
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Bile, Vomiting, Neonate, Surgery
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