Epidemiology

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.

and the attending

neonatobogist)
observed
a unilatenab or bilateral
inguinal
bulge on scrotal
mass that
was reducible
and recurrent.3
Because
assignment
of the diagnosis
of inguinal
hernia
was made prior
to discharge,
periods
of observation
varied
with
length

of hospitalization.

Birth

weight,

gestational

age (by mothers

last menstrual
period),
race,
den, and weight
for gestational
age5 (appropriate
gestationab
age, tenth
to 90th percentile)
data
sought
selection

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

the Mantelused to test

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-

and the signifiwith decreas-

ing birth weight

were tested
by x2 trend
analysis.7
A P value of <.04 was considered
significant.

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

was noted in neonates

(P < .002),
with

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

for all comparisons

Yates
correction

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

Vol. 77 No. 2Downloaded

February
1986
from by guest on May 20, 2016

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

Wt for gestational age

AGA

decreasing

on by

REFERENCES
1. Walsh
infants.

SZ:

The

incidence

of external

hernias

in premature

Acta Paediatr
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
and Care.
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
and Caucasion
birth weight-gestational
age tables.
Pediatrics 1970;46:9
6. Ballard
JL, Kazmaier
K, Driver M: A simplified
assessment
7.
8.

of gestational
Scherselman

age, abstracted.
Pediatr
Res 1977;1 1:374A
JJ:
Case Control
Studies:
Design,
Conduct,
Analysis.
New York,
Oxford
University
Press,
1982
Moore
KL (ed): Development
of the inguinal
canals,
in The
Developing
Human,
ed 2. Philadelphia,
WB Saunders
Co,
1977, pp 239-240,
253-254

9. Lang

DJ:

congenital

The

association
cytomegalic

of indirect

inguinal

inclusion

disease.

hernia
with
Pediatrics

1966;38:913

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PEDIATRICS
Vol. 77 No. 2 February

1 986

247

Epidemiology of Inguinal Hernia in Preterm Neonates

KEITH J. PEEVY, FELICITY A. SPEED and CHARLES J. HOFF
Pediatrics 1986;77;246
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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.

Downloaded from by guest on May 20, 2016

Epidemiology of Inguinal Hernia in Preterm Neonates

KEITH J. PEEVY, FELICITY A. SPEED and CHARLES J. HOFF
Pediatrics 1986;77;246

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.

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