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      Can early surgery improve the outcome of patients with meconium peritonitis? A single-center experience over 16 years

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          Abstract

          Background

          In the last century, meconium peritonitis(MP)was once a highly fatal gastrointestinal. disease With the development of fetal radiological technology, abnormal signs, such as pseudocysts, can. be detected during the fetal period so that more patients can be diagnosed prenatally and receive surgery. in the early stage of life. The survival rate of MP has increased up to 80% in recent years. According to. a review of the treatment and outcomes of patients diagnosed with MP, we evaluated the influence of. early operation on survival rate and discussed the risk factors of prognosis.

          Methods

          We collected 79 cases of patients diagnosed with MP who were treated in our department. from October 2001 to December 2017. They were divided into 2 groups. Patients in group A were born. in our hospital. Patients in group B were born in a local hospital with suspicion of MP and then transferred. to our department.

          Results

          The birth weight (BW) and gestational age (GA) of patients were higher in group A than in. group B. There was no significant difference in the proportion of premature and low birth weight (LBW). patients between the two groups ( p = 0.422, p = 0.970). Their age at the time of surgery was younger in. group A than in group B (1.4 ± 2.0 vs. 6.9 ± 14.9, p < 0.001). The overall survival rate of group A was higher. than that of group B (95.0% vs. 79.5%, p = 0.038). The prognosis of premature patients was worse than. that of full-term infants for both groups ( p = 0.012).

          Conclusions

          Prematurity is a significant risk factor related to death for MP patients. The survival rate. of MP patients can be improved by early operation during the neonatal period.

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          Most cited references17

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          Experience with meconium peritonitis.

          Meconium peritonitis is a sterile chemical peritonitis resulting from intrauterine bowel perforation. With the development of neonatal care, the prognosis of meconium peritonitis improved much. We report our clinical experience. The medical records of patients with meconium peritonitis admitted to the Asan Medical Center from June 1989 to July 2006 were retrospectively reviewed. Of 41 patients (17 males, 24 females), 38 (92.7%) were suspected to suffer from meconium peritonitis prenatally, at a median gestational age of 32 weeks (range, 21-40 weeks). The most common prenatal sonographic finding was fetal ascites followed by dilated bowel. Ten patients were managed conservatively, but 31 patients underwent operations including resection and anastomosis (22), drainage procedure (4), ileostomy (3) and primary repair (2). The operative 31 cases comprised generalized (16), fibroadhesive (10), and cystic types (5). The main causes were intestinal atresia and idiopathic bowel perforation. The mortality rate was 2.4%, and the morbidity rate was 34.1%. Good survival rate was achieved. But there was rather high morbidity. More gentle and delicate approach should be done to lower the morbidity.
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            Uses and misuses of albumin during resuscitation and in the neonatal intensive care unit.

            Albumin is one of the most abundant proteins in plasma and serves many vital functions. Neonatal concentrations vary greatly with gestational and postnatal age. In critically ill neonates, hypoalbuminemia occurs due to decreased synthesis, increased losses or redistribution of albumin into the extravascular space, and has been associated with increased morbidities and mortality. For that reason, infusion of exogenous albumin as a volume expander has been proposed for various clinical settings including hypotension, delivery room resuscitation, sepsis and postoperative fluid management. Albumin is often prescribed in infants with hypoalbuminemia, hyperbilirubinemia, and protein-losing conditions. However, the evidence of these practices has not been reviewed or validated. Albumin infusion may initiate highly complex processes that vary according to the individual and disease pathophysiology. Indeed, it may be associated with harms when misused. In this review, we critically appraise the scientific evidence for administering albumin in most conditions encountered in the neonatal intensive care unit, while emphasizing the benefits and risks associated with their use.
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              Postnatal changes in the relative abundance of intestinal Lactobacillus spp. in newborn calves

              The intestinal microbiota of newborn calves changes during the early postnatal period and influences their health and immune function. We studied the compositional changes in the intestinal microbiome of newborn calves during the first week after birth by metagenomic analysis. In feces from newborn calves, we identified 4 bacterial phyla, namely, Actinobacteria, Bacteroidetes, Firmicutes and Proteobacteria. The relative abundance of Lactobacillaceae significantly increased from day 1 to day 7. We evaluated Lactobacillus spp. colony numbers using selective agar plates and confirmed that the abundance of Lactobacillus spp. significantly increased during the first 7 days after birth. In conclusion, Lactobacillus spp. colonized the intestinal tract of calves during the first 7 days after birth.
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                Author and article information

                Contributors
                gracie_jiang@foxmail.com
                whpan2003@yahoo.com
                wuwenjie0416@126.com
                1872545444@qq.com
                suna.sun@usz.ch
                jwangjl@126.com , wangjun@xinhuamed.com.cn
                Journal
                BMC Pediatr
                BMC Pediatr
                BMC Pediatrics
                BioMed Central (London )
                1471-2431
                3 December 2019
                3 December 2019
                2019
                : 19
                : 473
                Affiliations
                ISNI 0000 0004 0368 8293, GRID grid.16821.3c, Department of Pediatric Surgery, , Xinhua hospital; Shanghai Jiao Tong University School of Medicine, ; No. 1665, Kongjiang Road, Shanghai, 200092 China
                Article
                1844
                10.1186/s12887-019-1844-5
                6889670
                31795969
                4053bca2-e754-4177-9278-3816ec2a18b7
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 21 August 2019
                : 20 November 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100010167, Shanghai Shen Kang Hospital Development Center;
                Award ID: 16CR3117B
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100008233, School of Medicine, Shanghai Jiao Tong University;
                Award ID: JQ201801
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Pediatrics
                meconium peritonitis,early operation,survival rate,premature,risk factor
                Pediatrics
                meconium peritonitis, early operation, survival rate, premature, risk factor

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