Clinical manifestations analysis of neonatal appendicitis

Abstract

Objective To retrospectively analyze the clinical characteristics, diagnosis and treatment of appendicitis in newborns, so as to reduce the occurrence of misdiagnosis and mistreatment. Methods The clinical data of 12 neonates with appendicitis from January 2007 to August 2017 in the Third Affiliated Hospital of Zhengzhou University were collected. The clinical manifestations, laboratory and imageological examination, diagnosis, treatment and prognosis of them were analyzed. Results Among the neonates with appendicitis, there were 6 premature infants, 6 full-term infants, 9 males and 3 females. The main initial symptoms included listlessness (9 cases), abdominal distension (9 cases), fever (7 cases), anorexia (7 cases) and vomiting (6 cases). All the twelve neonates had increased C reactive protein and proportion of neutrophils in varying degrees, and the leukocyte count was mainly increased. Performed peritoneal effusion cultivation was performed in 10 cases, which was negative in 3 cases and positive in 7 cases, including 3 cases of Escherichia coli, 2 cases of Klebsiella pneumoniae and 2 cases of Enterococcus faecium. Abdominal vertical X-ray and abdominal color Doppler ultrasonography were usually selected in abdominal imageological examination for clinical examination. Three were 8 cases proved by laparotomy, 3 cases proved by abdominal color Doppler ultrasonography and 1 case proved by abdominal computed tomography (CT). Eleven cases were treated by surgery and 1 case was treated by conservative treatment, including 8 cases of appendiceal perforation found in surgery. Pathological examination was performed in 10 cases druing operation, and the results showed that acute suppurative appendicitis was predominant. Finally, 9 cases were cured and 3 cases died. No postoperative complication or complications of digestive system was found in follow-up studies of 8 cases cured neonates, and 1 case lost to follow up. Conclusions The early clinical symptoms of neonatal appendicitis are not typical and it often leads to the high perforation rate and high mortality. Clinicians should improve the understanding of neonatal appendicitis to reduce the incidence of misdiagnosis and mistreatment. Key words: Appendicitis; Neonatal; Diagnosis; Prognosis