Biomedical subjects
Publications and source records attributed to Nigel Hall.
Necrotizing enterocolitis is the principal cause of surgical referral in preterm neonates and the most common gastrointestinal emergency among infants. Its pathophysiology is unclear and it carries high levels of mortality and morbidity. This article provides an overview of necrotizing enterocolitis including risk factors, preventative strategies and medical and surgical management.
With the improvements in neonatal intensive care, necrotizing enterocolitis (NEC) has become the most common gastrointestinal emergency amongst infants in neonatal intensive care units. The incidence of NEC varies between 1 and 8% of neonatal intensive care unit admissions and the disease has a mortality rate between 20 and 40%. There are a number of surgical options available to the paediatric surgeon depending on the clinical condition of the infant and the extent of the disease. However owing to a paucity of prospective data in this field and a lack of randomized controlled trials there is little consensus as to which is the most appropriate. Primary peritoneal drainage has become very popular in North America and Europe for the treatment of perforated NEC in very low-birthweight infants. It is a useful manoeuvre in the resuscitation of critically ill infants and in some of these infants, further operation may be avoided completely by inserting a peritoneal drain. Others however remain too unwell to undergo laparotomy and may die. Two randomized controlled trials are currently underway to determine the real benefit of peritoneal drainage. Laparotomy in very small neonates has become safer with improvements in anaesthesia and intensive care management. Resection and primary anastomosis has been proposed as a valid treatment modality in neonates with both focal and multifocal disease. The advantage of resection and primary anastomosis over stoma formation is still controversial. Different surgical techniques such as diverting jejunostomy or 'clip and drop' have been described to deal with extensive disease and avoid massive small bowel resection. Prospective studies and randomized controlled trials are needed to define the best operative treatment for neonates with severe NEC.
BACKGROUND: Intralesional injection of OK-432 has been proposed as an effective treatment of lymphangioma. The aim of this study was to review our experience with OK-432 injection of lymphangioma and to identify factors associated with successful outcome. METHODS: We made a case note review of 19 children who received OK-432 injection. Median duration of follow-up was 17 months. RESULTS: Lesions were diagnosed antenatally in 4 children, at birth in 4 children, and between 1 month and 11 years in the remainder. Anatomic locations were head/neck in 14, axilla in 1, and multiple locations in 4. Median number of injections per child was 2 (range, 1 to 5). Disappearance of the lesion was achieved after OK-432 injection in 2 patients (11%) and a marked reduction in 5 (26%); all these lesions were in the head and neck. Lesions larger than 5 cm and those outside the head and neck region did not respond well to OK-432 injection. Fourteen children (74%) required surgical excision after injection. Complications of OK-432 injection included partial tracheal obstruction, fever, local inflammatory response, and abscess formation. CONCLUSIONS: OK-432 injection was effective in approximately one third of children with lymphangioma. Lesions outside the head and neck and those larger than 5 cm are unlikely to respond to this therapy. Injection of lymphangioma surrounding the airways may be hazardous.