Thomas V. Santulli

An experimental study of acute neonatal enterocolitis—the importance of breast milk☆

Abstract Formula feeding in conjunction with hypoxia produces enterocolitis in newborn rats. Breast feeding under the same circumstances is completely protective. Enteric overgrowth of potentially pathogenic bacteria in only the formula-fed rats indicates that the gut flora plays an important role in the pathogenesis of enterocolitis. Breast milk through induction of passive enteric immunity and control of intestinal flora protects the rat and may protect at-risk premature infants from acute enterocolitis.

Surgical experience with necrotizing enterocolitis in the infant

Summario in interlingua Enterocolitis necrotisante es un morbo de neonatos que es altemente mortal. Illo se vide principalmente in prematuros e es characterisate per un tableau clinic de retention gastric, vomito biliari, distention abdominal, e feces a striation sanguinee o—a vices—diarrheic. Iste tableau resimila a vices, super toto initialmente, illo de obstruction intestinal. Perforation es un occurrentia commun. A base de un studio de 25 casos, le conclusion es formulate que perforation intestinal-manifeste in pneumoperitoneo roentgenographic—es le sol clar indication pro un intervention chirurgic.

Necrotizing enterocolitis in term infants

Despite the fact that necrotizing enterocolitis is considered a disease of premature infants, 20% of all affected infants at Babies Hospital over the past 20 years were products of term gestations. Two distinct subgroups of such infants were noted (1) five infants with congenital heart disease and/or congestive heart failure (e.g.hypoplastic left heart syndrome), all but one of whom developed the disease in the first week of life; (2) eight infants who developed the disease at a much later age after a protracted period of diarrhea. This histopathologic features of the disease in term infants are the same as those in premature infants. Further, the pathogenesis of the disease in term infants does not appear to differ basically from that in premature infants. These facts, lead away from the concept of NEC as a disease of simple etiology.

Midgut Malrotation and Volvulus

Abstract Midgut malrotation is a surgical emergency usually seen in the first weeks of life. It presents with duodenal obstruction and bile emesis; the signs may be intermittent or minimal. The advantages and limitations of plain films, barium enema studies, and gastrointestinal studies were reviewed in 77 patients with malrotation; volvulus was seen in 65. Additional experience was gained from a questionnaire among members of the Society for Pediatric Radiology. Barium enema studies were preferred by 39 respondents. The upper gastrointestinal series was useful in defining extrinsic duodenal obstruction, but was difficult to interpret if the patient was asymptomatic when studied.

Imperforate anus: A survey from the members of the Surgical Section of the American Academy of Pediatrics+

T ttlS REPORT is based on a survey of the experience of members of the Surgical Section of the American Academy of Pediatrics with imperforate anus for the 5-yr period 1965 through 1969. The authors are the committee appointed to compile d~tta from answers to a questionnaire circulated to 301 members, including honorary overseas members. Many of the members reported as groups from the same institution. The survey represents the experience of pediatric surgeons reporting on 1166 patients from 51 institutions, including childrens hospitals and general hospitals.

Neonatal hypermagnesemia and the meconium-plug syndrome.

THE administration of magnesium sulfate to eclamptic women may be associated with hypermagnesemia in the newborn infant, with the development of respiratory depression, lethargy, flaccidity and hyp...

Selective management of iatrogenic esophageal perforation in the newborn

Since 1974 nine neonates have been treated for iatrogenic esophageal perforation. They ranged in weight from 480 to 3900 g. Four of them had been resuscitated for meconium aspiration, four were being treated for respiratory distress syndrome (RDS), and one had received only routine postpartum suctioning and gastric aspiration. In five infants, esophageal perforation was suspected following traumatic intubation of difficulty in the passage of a catheter or tube. Three neonates passed formula from chest tubes placed for pneumothorax and one child presented with persistent pneumothorax. Esophageal perforation was documented in each case by direct visualization and/or radiographic studies. Three infants were treated with antibiotics and placement of a silastic nasogastric feeding tube. An additional two infants were treated with a silastic tube, antibiotics and chest tube drainage. Four children underwent operation: gastrostomy and drainage (2), gastrostomy and closure of perforation (1), gastrostomy only (1). There were no complications of deaths. Management of iatrogenic perforation of the esophagus depends upon the extent and location of the injury. A nonoperative approach can be successful in those infants with limited injury of short duration. Operation is required in cases with extensive extravasation or delay in diagnosis.

Microcolon in Newborn Infants with Intestinal Obstruction

Microcolon is the radiologic finding of a colon of tiny caliber on barium-enema examination of newborn infants with intestinal obstruction. It signifies only that the obstruction is above the colon. Barium-enema studies have shown that many infants with intestinal obstruction above the colon do not have “microcolon.” This finding led to a review of the size of the colon in newborn patients with all levels of intestinal obstruction. The colon caliber has been correlated with both the level and the time of onset of the fetal intestinal obstruction. Factors Normally Dilating the Fetal Colon The fetal gastrointestinal tract is a site of active work throughout the last two trimesters of pregnancy (1). The fetus actively swallows amnion, and this fluid load, estimated at several liters a day, mixes with gastric juice, bile, and the desquamated intestinal cells and succus entericus to form meconium, the feces of the fetus. Normally, the mixture becomes less fluid in the lower small bowel as amnion is absorbed; t...

Choledochal cyst: A review of 19 cases

Nineteen cases of choledochal cyst are reviewed. Two distinct groups of patients were identified. Patients under one year of age, initially diagnosed as having biliary atresia, had a higher mortality rate, a higher incidence of severe cirrhosis with portal hypertension, and associated atresia or stenosis in the biliary tree. The second group, presenting between 3 and 20 years of age with more classic symptoms, had mild cirrhosis without portal hypertension and had associated choledocholithiasis and pancreatitis. It is suggested that the younger patients had a congenital form of cystic bile duct dilatation and that the older patients had an acquired form, perhaps related to a common channel with reflux of pancreatic juice into the common bile duct. Postoperative follow-up supports the current view that choledochocyst-jejunostomy with choleystectomy has a lower rate of long-term complications than does choledochocyst-duodenostomy.

The radiologic evaluation of imperforate anus. An approach correlated with current surgical concepts.

In 1930 Wangensteen and Rice (9) introduced the still widely used technic of obtaining upside-down abdominal roentgenograms in newborn infants with “imperforate anus.” They made no measurement of any type, but merely employed the apparent distance between the rectal gas and anal dimple in planning surgical therapy. Subsequently, various measurements were devised including a distance of 1.5–2 cm between the rectal gas and anal marker; if this distance was exceeded, the perineal approach for correction was not used. Bony reference points were also considered (5), including the pubococcygeal line and ischial point (8); if the gas terminated above the pubococcygeal line, the perineal approach again was not advised. All these methods obviously were aimed at guiding the surgeon by placing patients into two major groups: those amenable to repair by the perineal route (“low”anomalies) and those not approachable solely from the perineum (“high” anomalies) (4, 6, 8). A basic assumption was implicit in all previous ...