Beruflich Dokumente
Kultur Dokumente
of Inguinal
Hernia in Preterm Neonates
The
incidence
is higher
in
of demonstrable
low
birth
panisons
inguinal
weight
and
hernias
very
of neonates
trols)
low
birth
and
as well
ies,
as the
on repetitive
although
financial
documenting
the
was
birth
to
weight,
uterine
detail
the
race,
gender,
growth
in neonates
incidence
weights
incidence
not
genthe
this
of gestational
and
birth
stud-
infants,
have
effects
of race,
retardation
on
The purpose
of
effects
on the
with
of
Prior
increased
of inguinal
hernias
in preterm
provided
complete
data on the
den, and intrauterine
growth
incidence
of inguinal
hernias.2
study
morbidity
hospitalization.4
age,
adequacy
of intra-
of inguinal
2,000
and
for gestational
by gender
were
computed
Haenszel
study
if they
2,000
were
g, had
followed
hernia
was
had
care
were
a birth
diagnosed
when
500
and
anomalies,
and
10 days.
Inguinal
two
observers
(F.A.S.
of hospitalization.
Birth
weight,
gestational
for
ing
method
the
each
criteria.
of the 397
Estimation
of Ballard
by evidence
from
ens last menstrual
neonates
who
of gestational
et ab6 was
physical
period
genfor
were
met
age
chosen
the
us-
if dates
examination
and
differed
by more
moththan
2
weeks.
Physical
examinations
to determine
gestationab age were performed
by housestaff
and were
reviewed
by the attending
neonatobogist.
Complete
data were available
on 388 neonates.
An unmatched
case-control
approach
was used
in
analysis
Reprint
ical
of the
requests
Center,
data.7
to (K.J.P.)
Department
Pairwise
University
of Pediatrics,
statistical
of South
2451
St,
MedMobile,
AL 36617.
PEDIATRICS
(ISSN
American
Academy
246
PEDIATRICS
0031
4005).
of Pediatrics.
Copyright
significance
of the
incidence
tween this
known
the
relative
association
mci-
between
the
g to 1751 to 2,000
g). The
1,751
was used as the baseline
(relative
1.0)
and
category
relative
cance
of
of inguinal
hernia
and low birth weight,2
neonates
were grouped
into six 250-g cate-
comparisons
and
were
all others.
incidences
x2 with
of increases
The
were
made
tested
Yates
correction,
in inguinal
hernias
be-
significance
by
Mantel-
relative
1986
by
the
incidence
of inguinab
hernias
in all
397
infants
categorized
by birth
weight
is shown
in
Table 1. A highly
significant
increase
in the relative
incidence
with
of inguinal
birth
hernias
weights
significant
inguinal
1,250
trend
hernias
of increasing
relative
in each
decreasing
group
(P < .001).
hernias
in 388
The
relative
infants
incidence
for whom
of inguinal
complete
data
by gestational
age (32
by weight
for gestational
those
is
32
weeks
shown
in
increase
in the relative
incidence
occurs
at 32 weeks
gestation
who were 32 weeks gestation
for
gestational
age
had
incidence
of
birth
weight
available
categorized
or >32 weeks)
and
Table
2.
were
weeks
age in
A
clear
of inguinal
hernias
(P < .02). Infants
and who were small
a significantly
increased
relative
incidence
of inguinal
hernias
when
cornpared
with infants
who were 32 weeks
gestation
and who were appropriate
for gestational
age (P <
.002).
For
TABLE
1.
Neonates
Categories
Birth
infants
who
were
small
for
gestational
Relative
Incidence
of Inguinal
Hernia
in
Grouped
According
to 250-Gram
Birth Weight
Wt
No. of
Infants
With
No. of
Infants
Without
Relative
mci-
P
Value
Hernia (%)
Hernia (%)
1,751-2,000
1,501-1,750
1 (1)
5 (6)
103 (99)
77 (94)
1,251-1,500
1,001-1,250
4 (5)
9 (14)
76 (95)
56 (86)
5.4
16.6
NS
<.002
13 (27)
7 (39)
35 (73)
11 (61)
38.3
65.5
<.001
corn-
Alabama
Fillingim
and
was
RESULTS
between
no major
congenital
for greaten
than
strat-
incidences
hernias
g.
at our institution
included
in the
weight
relative
gonies
(501 to 750
to 2,000 g category
Haenszel
race.
age
The
statistical
of the
weight
and
x2 with
dences.7
Because
The
received
period
age,
ified
METHODS
All neonates
who
during
a 24-month
(cases)
gestational
presence
all 397
prolonged
(con-
hernias
by race, gender,
gesta>32 weeks),
weight
for
inguinal
hernias
may
rent apnea,
anesthesia
complications,
hernias
inguinal
separately
weeks
and
the
risks of recurpostoperative
inguinal
with
were performed
tional
age (32
weight
neonates
than
in normal
term neonates.2
All infants
with inguinab
hernias
are at risk for
bowel
incarceration
and vascular
compromise
of
bowel
and gonadab
tissue.3
Preterm
infants
with
incur
increased
morbidity,
and
without
neonates
751-1,000
501-750
dence
1.0
6.7
NS
<.001
TABLE
2.
Relative
Incidence
Neonates
Grouped
Weight
for Gestationab
Gestational
>32 wk
32
of
According
to
Inguinal
Hernia
Gestational
Age
in
and
Age*
No. of
Infants
No. of
Infants
Relative
With
Hernia
(%)
Without
Hernia
(%)
Incidence
P
Value
increased
risk
study
wk
34
(13)
116
(96)
1.0
233
(87)
3.4
The
wk
20 (9)
wk
194
14 (26)
AGA,
used:
age; SGA,
small
age, male
incidence
infants
32
of inguinal
(91)
1.0
39 (74)
appropriate
for gestational
fants
3.5
<.002
for gestational
weeks
were
appropriate
age.
for gestational
age,
both
sexes
32
dence of inguinal
hernias
and gender
or quality
of
intrauterine
growth.
No significant
associations
were found
between
incidence
of inguinal
hernias
and race in any group.
32
weeks
of
have
gestation,
entered
the
the
scrotum
testes
and
a similar
vaginalis
gestational
may
remain
in most
term
infants,
less
ically
detectable
inguinal
than
in
males
age.8 Although
a potential
expectation.
increased
only
for
infants
prolonged
a 5%
greaten
hernias
gestational
nutrition
structures
the
possible
in the
infants
with
must
birth
difficult
the
sample
size
small
II statistical
be
observation,
of inguinal
through
bias
of
ges-
to 1,500
still
had
hernias.
increase
in risk of inguinal
infants
who are small
for
clear.
Deficient
intrauterine
contraction
of the
inguinal
altered
hormonal
stimuli
age
is not
the
lack
ex-
(five
cases,
bias
(>32
of expected
to explain
but
in-
easily
gender
may
reflect
116 controls)
(type
We
have
studied
the
epidemiology
hernias
in preterm
infants.
with
increased
frequency
gestational
age or
infants
32
weeks
growth
retardation
Our
of inguinal
Inguinal
in infants
hernias
32
occur
weeks
1,250
g birth
weight.
Among
gestational
age,
intrauterine
significantly
increases
the risk
of inguinal
hernias,
data
demonstrate
association
and intrauterine
especially
a previously
between
growth
J. PEEVY,
MD
A. SPEED,
RN
CHARLES
J. HOFF,
PHD
Departments
of Pediatrics
in
neonatal
retardation.
in-
KEITH
FELICITY
of South
and
Alabama
Medical
Medical
Genetics
Center
Mobile
in neonatal
inguinal
hernia
in assointrauterine
growth
retardation
has
been reported.
The reason(s)
for a
than
threefold
among
preterm
age is not
may
delay
per-
in inguinal
gestational
age
be
not
error).
University
considered.
1,251
were
SUMMARY
dinbowel.
smaller,
weights
hospitalized
incidence
An increase
ciation
with
not previously
study,
observation
immature
However,
g, with
In our
time
tationally
age),
is also
the
space
When
pneterm
delivery,
with its accompanying
increase
in intnaabdominal
pressure,
occurs
prior to
testicular
descent
or contraction
of the inguinal
canal,
an increase
in clinically
apparent
inguinal
hernia
would be expected.3
Our data, categorized
by
gestational
age or birth weight,
are consistent
with
this
gestational
unrecognized
guinal
hernia
contractune
5% experience
herniation
of
cannot
increase
for
gestational
influence
of the inguinal
canal around
the spenmatic
cord has
begun.8
Presumably,
contraction
of the female
inguinal
canal
and narrowing
of the canal
of Nuck
occurs
at
processus
cultures
small
of cy-
findings
a marginal
weeks
for development
male
infants.
DISCUSSION
By
contribution
to our
male
none
of cytome-
32
weeks
gestation
had similar
incidences
of inguinal
hernias.
In infants
>32 weeks
gestational
age, no
significant
associations
were
noted
between
mci-
normally
for
associand
an
Although
stigmata
possible
routine
layers.
are
plained
but could be attributed
to statistical
due to small
sample
size. In older
neonates
weeks gestation
had a greater
hernias
than
female
infants
(P = .074);
for infants
who
gestation
the
hernia.9
overt
infection
among
weeks
32
had
reason
fascial
infections
growth
retardation
inguinal
because
hernias
of involved
of
infection,
excluded
formed.
<.02
strength
infants
tomegaboviral
5 (4)
SGA s32
*Abbreviations
cytomegalovinal
intrauterine
gaboviral
age
32
tensil
Congenital
ated
with
of the
AGA
decreasing
on by
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1. Walsh
infants.
SZ:
The
incidence
of external
hernias
in premature
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1962;51:161
2. Harper
RG, Garcia
A, Sia C: Inguinal
hernia:
A common
problem
of premature
infants
weighing
1000 grams or less
at birth. Pediatrics
1975;56:112
3. Filston
HC, Izant
R (eds):
Inguinal
hernia
and hydrocele,
in
The
Surgical
Neonate:
Evaluation
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New
York,
Appleton-Century-Crofts,
1978, pp 241-244
4. Steward
DJ: Preterm
infants
are more prone to complications
following
minor
surgery
than
are term
infants.
Anesthesiology
1982;56:304
5. Freeman
MG, Graves
WL, Thompson
RL: Indigent
Negro
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Pediatrics 1970;46:9
6. Ballard
JL, Kazmaier
K, Driver M: A simplified
assessment
7.
8.
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Scherselman
age, abstracted.
Pediatr
Res 1977;1 1:374A
JJ:
Case Control
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Oxford
University
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1982
Moore
KL (ed): Development
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canals,
in The
Developing
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ed 2. Philadelphia,
WB Saunders
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253-254
9. Lang
DJ:
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The
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Citations
Reprints
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007.
Copyright 1986 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005.
Online ISSN: 1098-4275.
The online version of this article, along with updated information and services, is located on
the World Wide Web at:
/content/77/2/246
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication,
it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked
by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village,
Illinois, 60007. Copyright 1986 by the American Academy of Pediatrics. All rights reserved. Print
ISSN: 0031-4005. Online ISSN: 1098-4275.