J.Jpn. Surg. Soc.. 91(9): 1287-1290, 1990

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Report on the annual meeting

CAUSE OF DEATH IN SURGICAL NEONATES： AN ANALYSIS OF 1019 CASES IN THESE 20 YEARS

In order to clarify the problems in the surgical neonates, the cause of death was analyzed in 119 cases which died postoperatively among 1019 surgical neonates during the period from 1970 to 1989 (mortality, 12%). The death rate improved from 16% in the first 10 years to 9% in the later 10 years totally, 45% to 7% in perforation of GI tract, 59% to 38% in gastric rupture, and 100% to 50% in necrotizing enterocolitis (NEC). While the mortality increased from 7% to 29% in congenital diaphragmatic hernia (CDH). In the later 10 years, 80 percent of deaths fell into 3 categories ; sepsis, respiratory failure, and severe associated anomalies. Fifteen cases out of 52 were died of sepsis caused by neonatal gastric rupture or NEC. Fifteen were died of respiratory failure caused by congenital diaphragmatic hernia (CDH) and severe airway anomalies. Eleven were died of associated multiple or severe cardiac anomalies.
Early diagnosis and plasmapheresis in sepsis, application of ECMO to CDH, and simultaneous correction of associated cardiac anomalies are the keys to improve the survival rate in the management of surgical neonates. The hospital and regional systems also should be reorganized to adapt the innovation of the surgical treatment in this field.

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