The term "spontaneous gastric rupture" is used to describe our cases of neonatal gastric perforation. Nineteen such neonates are reviewed. Current opinions regarding the possible etiology is included in the discussion. Neonatal asphyxia was the most commonly seen predisposing cause in our series (63%). Roentgenograms of the abdomen are most helpful in making a positive diagnosis. Surgical repair is the treatment of choice. All the surviving patients in our series underwent surgical repair. The need for gastrostomy during surgery should be individualized. The mortality was 27% in the cases operated since 1970; a significant improvement as compared to a mortality rate of 62% for the cases operated before 1970.
Three children, aged 9 days, 3 weeks, and 9 1/2 months, were treated for Fournier's syndrome. The portals of entry for a miscellaneous group of pathogens included a circumcision in the first, a circumcision and a diaper rash in the second, and a hot water burn in the third. The development of the condition after a circumcision is noteworthy because it is an extremely common surgical procedure. Medical and minor surgical treatment of the gangrenous areas during the period of rapid healing was successful. This approach contrasts with those researchers who recommend grafts. All three children survived, although one died three years later of complications from the original burn, and in another, one testicle could not be palpated after healing.
An infant weighing 740 gm at birth underwent right internal jugular venous cannulation for the administration of parenteral nutrition at age 17 days. The roentgenogram obtained to assess catheter placement revealed a high right diaphragm for the first time in the course of the infant. The phrenic palsy was incurred during the cutdown in the neck of the tiny, then 650 gm, infant. Two similar patients are mentioned in the literature. The phrenic palsy appeared to delay improvement in the respiratory status of this infant. This patient illustrates the fact that phrenic nerve palsy is a potential complication of central line placement in the neck of a very low birthweight infant.
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