2584

NECROTIZING ENTEROCOLITIS FOLLOWING REPAIR OF GASTROSCHISIS

Ming-Cheng Wei, Tsang-Chi Lin, Chien-Hsing Lee, Wen-Tsung Hung

Changhua Christian Hospital, Changhua, Chinese Taipei

Backgroud: Nccrotizing enterocolitis after repair of gastroschisis has been documented in around 15~20% and is responsible for significant morbidity We analyzed our database and try to find out the factors.

Method and Materials: There were 41 cases of gastroschisis , treated in our hospital between 1985 and 1999.Clinical data, prenatal diagnosis, mode of delivery, gestational age and birth weight , type of closure, presence of associated anomalies were analyzed.

Results: A total of 41 newborns with gastroschisis were treated. Thirty-three cases underwent primary fascial closure with 4 deaths, 6 underwent staged closure using Silon Pouch with 3 deaths, 2 underwent skin flap closure without death, Six cases developed NEC after primary fascial closure in which two cases progressed to intestinal perforation and expired. Two cases developed NEC after staged closure using Silon Pouch, in which two cases progressed to intestinal perforation and one expired Mean onset of NEC, from repair of gastroschisi to development of NEC was 11 days (range 3 to 18 day). The survival rate of NEC with intestinal perforation was 25% and 75% in cases without intestinal perforation Through review of clinical data, all eight babies developed NEC had a rapidly worsing general condition marked by dehydration, shock, oliguria, paralytic ileus, and sepsis. These symptoms persisted usually from immediately after closure.

Conclusion: 41 cases of gastroschisis were treated in our clinic, eight cases developed nccrotizing cntcrocolitis after repair of gastroschisis Four progress to intestinal perforation and three expired. The mean onset of NEC, from repair of gastroschisi to development of NEC was 11 days. All 8 cases had a rapidly worsing general condition immediately after repair of agstroschisis. Compare our data with published literatures, cases reported here developed NEC in the early stage following repair, clinic symptoms more severe and mortality higher.