Analysis Of Clinical Features And Prognostic Factors Of Meconium Peritonitis

Objective:To investigate the clinical characteristics and prognostic factors of meconium peritonitis(MP).Methods:Clinical data of 60 children with meconium peritonitis treated by operation in neonatal surgery department of Shanxi Children’s Hospital from October 2011 to September 2020 were retrospectively analyzed.The clinical data including clinical manifestations,auxiliary examination,operation,postoperative complications and prognosis were analyzed.Children were divided into survival and death groups based on their prognosis.To analyze the relationship between the factors such as prenatal diagnosis,sex,premature infants,low birth weight infants,early operation,preoperative white blood cells,preoperative C-reactive protein(CRP),preoperative albumin,operation mode,operation time,pathological type,postoperative short bowel syndrome,postoperative intestinal obstruction,postoperative necrotizing enterocolitis and other factors and the prognosis,and explore the related factors affecting the prognosis.Univariate analyses were performed using thex~2test(or continuous-correctedx~2test),independent sample T-test or rank-sum test.P<0.05 was considered statistically significant.Logistic regression was used for multivariate analysis.P<0.05 was considered statistically significant.Results:(1)Of the 60 patients,25(41.7%)were boys and 35(58.3%)were girls.There were27(45.0%)premature and 33(55.0%)full-term babies.Their gestational age ranged between 29+1 and 40+1 weeks with an average of(36.76±2.41)weeks.There were27(45.0%)premature and 33(55.0%)full-term babies.Their gestational age ranged between 29+1 and 40+1 weeks with an average of(36.76±2.41)weeks.There were19(31.7%)low birth weight infants and 41(68.3%)non low birth weight infants.Their birth weight ranged between 1300 and 4700 g with an average of(2924±676)g.(2)All the 60 children had different degrees of abdominal distension or vomiting.(3)According to the etiology of MP,there were 42 cases of simple intestinal atresia(70.0%),5 cases of intestinal atresia combined with torsion(8.3%),3 cases of necrotizing enterocolitis(5.0%),1 case of intestinal atresia combined with malrotation(1.7%),1 case of intestinal atresia combined with intestinal duplication(1.7%),1 case of intestinal stenosis(1.7%),1 case of meconium embolism syndrome(1.7%)and 5 cases of unknown etiology(8.3%).According to the pathological features,44 cases(73.3%)were classified as fibrous adhesion type,11 cases(18.3%)as cystic type,and 5 cases(8.3%)as extensive type.(4)All the children underwent surgery after admission.According to the intraoperative situation,stage I enterostomy was selected in 30 cases(50.0%)and enterostomy in 30 cases(50.0%).In this study,23 cases(38.3%)had postoperative complications,including 6 cases(10.0%)of short bowel syndrome(2 cases after phase I anastomosis and 4 cases after enterostomy),6 cases(10.0%)of intestinal obstruction,5cases(8.3%)of necrotizing enterocolitis,2 cases(3.3%)of retraction/prolapse of fistula,2 cases(3.3%)of septic shock,1 case(1.7%)of anastomotic leakage and 1 case(1.7%)of sepsis.(5)Of the 60 patients,48(80.0%)survived,3(5.0%)died in hospital,and 9(15.0%)died outside the backyard due to various reasons.(6)Univariate analysis:the rates of preoperative CRP and postoperative short bowel syndrome in the death group were significantly higher than those in the survival group.The proportion of preoperative albumin and early operation in the death group were lower than those in the survival group.Multivariate analysis:preoperative elevated CRP and postoperative short bowel syndrome were risk factors for death of MP children;early orperation is a protective factor for the death of children with MP,and early operation can reduce the risk of death.Conclusion:Intestinal atresia is the most common cause of MP.Prenatal abdominal ultrasound of MP children often indicates abnormalities.Postpartum imaging examination shows intestinal dilatation and high-density calcification or cystic mass in abdomen.Whether early operation,preoperative CRP and whether merger short bowel syndrome after operation are important factors affecting the prognosis of MP children.