Purpose:The aim of this research is to study the predictors of neonatal surgical mortality (NSM)-defined as in-hospital death or death within 30 days of neonatal surgery.Materials and Methods:All neonates operated over the study period of 18 months were included to evaluate NSM. The evaluated preoperative and intraoperative variables were birth weight, gestation age, age at presentation, associated anomalies, site and duration of surgery, intraoperative blood loss, and temperature after surgery. Assessed postoperative variables included the need for vasopressors, postoperative ventilation, sepsis, reoperations, and time taken to achieve full enteral nutrition. Univariate and multivariate logistic regression was applied to find the predictors of mortality.Results:Based on patient's final outcome, patients were divided into two groups (Group 1-survival, n = 100 and Group 2-mortality, n = 50). Incidence of NSM in this series was 33.33%. Factors identified as predictors of NSM were duration of surgery >120 min (P = 0.007, odds ratio [OR]: 9.76), need for prolonged ventilation (P = 0.037, OR: 5.77), requirement of high dose of vasopressors (P = 0.003, OR: 25.65) and reoperations (P = 0.031, OR: 7.16 (1.20–42.81).Conclusion:NSM was largely dependent on intraoperative stress factors and postoperative care. Neonatal surgery has a negligible margin of error and warrants expertize to minimize the duration of surgery and complications requiring reoperations. Based on our observations, we suggest a risk stratification score for neonatal surgery.
Approximately 10% to 15% of patients with infantile hemangioma (IH) require treatment that needs to be individualized according to the size, location, and type of IH. Oral corticosteroids [CS] have been the mainstay of therapy, but dose and duration of therapy have been variably reported in literature. The possible side effects with high dose CS is a constant deterrant. Twenty infants with IH requiring therapy were treated with prednisolone at a dose of 3 to 4 mg/kg/day. Response to therapy, adverse effects, and risk of rebound growth were monitored. All of the treated lesions responded to prednisolone at 3.1 mg/kg/day given for a mean duration of 9.16 weeks by showing a cessation of active growth; 90% of patients showed partial to excellent response (Grade 2 to Grade 4 improvement). In the remaining 10% of patients there was <25% regression in the lesion. The total duration of therapy with tapering doses was 29.9 weeks. No cases of rebound growth were seen. The incidence of adverse effects was low, with one patient developing CS-induced hypertension (5%). Oral CS, given at appropriate doses, are a reasonably safe and highly efficacious treatment modality for IH. To prevent the risk of rebound growth, adequate prolongation of therapy is required.
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