235 Vol. 36, pp. 235243, 2008 25 643 : 20 6 24 1982 2006 25 643 6.5 1.4 : 1 50 57 30 10 643 62 96 5 20 5 56p 0.05 5 12.6 5 8.6 44.827.7 19.518.8 1,500 g 1500 g 31.7 vs 3.6, P0.001 5 1960 1964 1982 220 25 1982 4 2006 3 25 37
236 Table 1. Clinical Data of Neonates with Surgical Disorders 15 9889 30 1 Esophageal atresia: 2 Bowel atresiastenosis: 3 Hypertrophic pyloric stenosis: 30 4 Malrotation of the intestine: 5 Hirschsprung Hirschsprung s disease and allied disorders 6 Meconium-related obstruction: 7 Anorectal anomalies: 8 Bowel perforation: 9 Abdominal wall defects: 10 Diaphragmatic hernia: Bochdalek 10 11: 12: 13: 38
25 237 Fig. 1. Case number of neonates and total inpatients per 5-year study period. 14 15 16 17: 25 1 5 198286, 198791, 199296, 19972001, 20022006 Ryan P0.05 1: 25 643 14:1 65 2526 Table 1 7.5 5 6.0Fig 1 2: 50 321 0 176 27.4 16 46 7.2 713 100 15.6 14 2500 g 68.61500 g1000 g 9.8 37 75 36 25 500 85 17 1986 118 1991 15 5 40.6 2003 55 Table 1 3: 10 79 57 36 Hirschsprung 35 32 30 29 27 18 9 18 360 Fig 2 392 32 ; 11 9 6 6 10 97 95 1 41 43 39
238 Fig. 2. Distribution of major neonatal surgical disorders. 2 6 16 11 1990 38 4 3 4 16 21 31 18 15 4: 565 363 435 Table 1 40 32 594357390 5: 581 62 9.662 643Table 1 9936363 20.025125 11.013118 p0.05 8.310120 4.36 138 5 5.68142 12.6 Fig 3 44.8 22.2 22.2 27.8; 11.1 18.2 8.9 3.5 50 42.9 42.9 37.5 p0.01 Fig 4 62 17 274 17 40
25 239 Fig. 3. Mortality rates for surgical neonates per 5-year study period. Fig. 4. Mortality rates for neonates with major surgical disorders. 3 3 4 6 DIC 4 Table 2 37.5 25.8 15002500 g 15.9 2500 g 3.6 1500 g 1500 g p0.01; Fig 5 1 1965 2003 5 41
240 Table 2. Causes of Death of Neonates with High Mortality Rate Fig. 5. Comparison of mortality for surgical neonates according to birth weight. 1964 60 2 2 Hirschsprung 2003 10 3 Quality of life QOL 42
25 241 Table 2 4 1980 59 6 1011 1213 14 65 15 1500 g 1500 g 5 1 13 18 Extrauterine intrapartum treatment; EXIT 6 20 1 Kramer MS, Liu S, Luo Z, Yuan H, Platt RW and Joseph KS. Analysis of perinatal mortality and its components: time for a change? Am J Epidemiol 2002; 156: 493497. 2 2003 2004; 40: 919943. 3 2007; 108: 313317. 4 Lakhoo K. Fetal councelling for congenital 43
242 malformations. Pediatr Surg Int 2007; 23: 509 519. 5 3 1995 4248. 6 2007; 108: 318324. 7 Murph FL, Mazlan TA, Tarheen F, Corbally MT and Puri P. Gastroschisis and exomphalos in Ireland 19982004. Does antenatal diagnosis impact on outcome? Pediatr Surg Int 2007; 23: 10591063. 8 3 2006; 42: 801805 9 RI 2005; 41; 170176. 10 28 2005; 41: 776782. 11 2007; 108: 333338. 12 1978 1979; 15: 907915. 13 1988 1990; 26: 1125. 14 2003; 19: 394406. 15 Chang AC, Hanley FL, Lock JE, Castaneda AR and Wessel DL. Management and outcome of low birth weight neonates with congenital heart disease. J Pediatr 1994; 124: 461 466. 44
25 243 Abstract RESULTS OF SURGICAL TREATMENT GIVEN TO NEONATES IN A SINGLE INSTITUTION: A 25-year analysis of 643 patients Hiroaki Kitagawa, Takeshi Aoba, Yasuji Seki, Munechika Wakisaka, Yoshitaka Kim, Misao Ishikawa, Teruhiro Fujioka, Tomotake Enami, Mikio Kuwahara, Fumio Kawaguchi, and Koonosuke Nakada. We evaluated the results of treatment in 643 neonates with various surgical disorders experienced during the past 25 years from April 1982 to March 2006. Of 643 neonatal patients, 321 patients roughly 50 were diagnosed on the first day of life, 176 27.4 within a week, 176 27.4 within 2 weeks, and 100 15.6 more than 2 weeks after birth. Among them, 363 patients 57 underwent surgery within 30 days after birth. Sixty-two 9.6 patients died during the initial hospital stay. The mortality rate for the patients in the initial 5-year study period was 20 which was significantly decreased to 5.6 for the patients in the most recent 5 -year study period p0.05. The mortality rate for patients with diaphragmatic hernia was 44.8, which was the highest mortality among patients with major diseases, followed by patients with bowel perforation 27.7, abdominal defects 19.8, and esophageal atresia 18.8. The mortality rate for low-birth weight 1500 g infants was significantly higher than for the higher-birth weight 1500 g infants 31.6 vs. 3.6, p0.001. Thus the outcome of the surgical neonates treated in our institution improved steadily throughout each 5-year study period. However, mortality for neonates with diaphragmatic hernia, abdominal wall defects, and bowel perforation remain high, because of recent increase of severe premature patients, chromosomal abnormalities combined with severe anomalies, and prenatally diagnosed more severe disorders. Key Words neonate, surgical disorders, treatment results, neonatal surgery, fetal surgery Division of Pediatric Surgery, St. Marianna University School of Medicine Kawasaki, Japan 45