Decreased mortality but increased morbidity in neonates with jejunoileal atresia; a study of 114 cases over a 34-year period

Abstract

Purpose The aim of the study was to evaluate patient demographics, classification and location of the atresia, operative management, postoperative care, and outcome in 114 infants with jejunoileal atresia (JIA) over a period of more than 3 decades. Methods This was a retrospective case series in a tertiary care teaching hospital. Records of all patients with JIA treated at the authors' institution between 1971 and 2004 were examined. Results Sixty-two percent of atresia and stenosis was noted in the jejunum, 30% in the ileum, and 8% in both the jejunum and the ileum. Atresias and stenosis were classified as follows: 7% type 0, 16% type I, 21% type II, 24% type IIIa, 10% type IIIb, 22% type IV. Gastrointestinal anomalies were encountered in 24% of patients, genitourinary malformations in 9%, cystic fibrosis in 9%, neurologic anomalies in 6%, and congenital heart disease in 4%. Operative management included resection with primary anastomosis in 69% of all patients and temporary enterostomies in 26%. After operative management, 15% of children had resultant short bowel syndrome. Oral feeding was allowed on median day 7, and full energy expenditure via the enteric route was reached on median day 20. Forty-seven percent of infants required central venous line placement for total parenteral nutrition. Early postoperative complications occurred in 28% of patients with JIA and late postoperative complications in 17%. We observed a mortality rate of 11%. Conclusions This is one of the largest series of neonates with JIA described. Short bowel syndrome seems to be the biggest problem resulting in longer hospital stay, more feeding problems, and higher morbidity and mortality rates. Management of children with short bowel syndrome has improved because of the use of total parenteral nutrition, new operative techniques, and better intensive care. In the last 15 years, survival has increased at the cost of the surviving children as we noted a higher percentage of late complications.