The outcome of critically ill neonates undergoing laparotomy for necrotising enterocolitis in the neonatal intensive care unit: a 10-year review

Results: 221 infants with NEC were referred for surgical evaluation; 182 (82%) underwent surgery; 15 (8%) required a laparotomy on NICU. Five had NEC totalis, 4 multifocal disease and 6 focal disease. Five had an open and close laparotomy, 8 stoma with/without bowel resection and 2 bowel resection and primary anastomosis. Ten (67%) died at a median of 6.5-hours (2-72) postoperatively; 2 died at 72 and 264-days. The 30-day mortality rate was higher (p = 0.01) among infants undergoing a laparotomy on NICU (10/15; 67%) than in theatre (54/167; 32%). There was no significant difference in mean Paediatric Index of Mortality 2 Scores between survivors and nonsurvivors (p = 0.55). Three (20%) infants remain alive with no or minimal disability at 1.4 (0.5-7.5) years. Conclusion: Laparotomy for NEC on NICU is a treatment option for neonates who are too unstable to transfer to theatre. However, with 67% dying within 6.5-hours and a further 13% after months in hospital, we must consider whether surgery is always in their best interests. Development of a prediction model to help distinguish those at highest risk of long-term morbidity and mortality could help with decision making in this difficult situation

Performance measures for upper gastrointestinal endoscopy:A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

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For how long should antibiotics be given in acute paediatric septic arthritis? A prospective audit of 96 cases.

Ninety-six cases of uncomplicated acute septic arthritis in children aged 12 years and under were treated by arthrotomy under general anaesthesia, saline washout and antibiotics for six weeks. They were prospectively studied for 24 weeks to assess clinical, haematological and radiological changes. Clinical improvement was most marked in the first two weeks and did not change significantly after six weeks. Haematological indices (haemoglobin concentration, serum white cell count and erythrocyte sedimentation rate) all improved from the start of treatment and continued to improve throughout the study, even after antibiotics were finished. Radiological changes in the bone adjacent to the infected joint were noted to be present in 21 cases by two weeks after presentation, and in a further 10 cases by six weeks after presentation, suggesting some continued infective activity in the bone adjacent to the septic joint even after two weeks of antibiotics. No new radiological changes were noted after six weeks. It is therefore suggested that antibiotics in septic arthritis should be continued for six weeks

Clinical features and microbiology in 204 cases of septic arthritis in Malawian children.

We examined 204 children (137 boys and 67 girls) aged 12 years and under with septic arthritis. Their mean age was 31.1 months (1 to 144; SD 41.6). The most common joints affected were the knees and shoulders. Joints in the upper limb were affected more often in younger children and in the lower limb in those who were older. The mean age for an infection was 12 months in the shoulder and 73 months in the hip. The most common organisms cultured were species of Salmonella

Does long-term chloramphenicol cause anaemia in Malawi?

Common clinical practice in many tropical paediatric departments is that chloramphenicol courses are limited to 2 weeks due to concerns about anaemia. However, this approach is not supported by current research and animal models. We used chloramphenicol for 6 weeks in 146 children with septic arthritis. All the children improved clinically. Most children were anaemic on presentation (mean haemoglobin [Hb] 8.43 SD 1.9), but the anaemia improved rapidly with clinical resolution of the infection and was maintained at 6 months after presentation (mean Hb 10.57 SD 1.86)