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Background: Alpha‐1‐acid glycoprotein is an acute‐phase protein with a high affinity for amide local anesthetics. Compared to adults, neonates have lower concentrations of this glycoprotein in plasma, and are therefore at higher risk of developing local anesthetic toxicity. Alpha‐1‐acid glycoprotein concentrations rise in adults after surgery as a response to stress as well as in inflammatory conditions. Previous studies have shown that concentrations of alpha‐1‐acid‐glycoprotein in neonates vary postpartum, influenced by gestational age and mode of delivery. Aim: This study aims to determine the concentrations of alpha‐1‐acid glycoprotein pre‐ and postoperatively in neonates undergoing major surgery. This information is important for determining safe and effective dosage of local anesthetic in this vulnerable group of patients. Methods: In this prospective observational study, 25 neonates (median 3 days of age) undergoing major surgery were included. Blood sampling was performed preoperatively and at four occasions postoperatively. Alpha‐1‐acid‐glycoprotein plasma concentrations were analyzed using an immunoturbidimetric assay. Mann–Whitney U test, Kruskal–Wallis and Spearman ranking correlation test were used for the statistical analysis. Results: Higher plasma concentrations of alpha‐1‐acid‐glycoprotein were found 48 h postoperatively compared to preoperatively [median (inter‐quartile range) 0.815 g L−1 (0.663–0.983 g L−1) vs. 0.300 g L−1 (0.205–0.480 g L−1p < 0.001)], respectively. It was not possible to detect any influence of sex, postnatal age, gestational age, or delivery mode on alpha‐1‐acid‐glycoprotein concentrations in our data. Conclusions: Alpha‐1‐acid‐glycoprotein concentrations increase in neonates as a response to surgery regardless of gestational age, sex, or mode of delivery. [ABSTRACT FROM AUTHOR]

Background/purpose To test the hypothesis that clinical and radiological features of necrotizing enterocolitis vary with gestational age in all neonates with NEC and in subgroup of surgically treated patients. Methods This was a retrospective study case series. NEC cases treated in Stockholm County from 2009 to 2014 were identified in the National Quality Register. Patients were included in the study if they had a verified NEC diagnosis and they were divided into 2 groups according to the gestational age. Results A total of 89 patients were included. Of these 60 (67.4%) neonates had a gestational age < 28 and 29 (32.6%) infants ≥ 28 weeks. Surgical NEC patients were 57 (64%). Pneumatosis intestinalis at the abdominal radiographs was noted significantly more often in neonates born at ≥ 28 weeks of gestation (86.2%) compared to extremely preterm newborns (60.0%). Neonates born at ≥ 28 weeks of gestation presented more often bloody stools (58.6%) compared to extremely preterm newborns (20.0%). In surgical NEC patients gasless abdomen was detected in 35.6% of the neonates born < 28 weeks compared to 6.7% of the more mature neonates. Conclusions Extremely preterm neonates with NEC show less specific clinical and radiological signs of NEC compared to more mature neonates. This suggests that Bell's classification is not adequate for the diagnosis and staging of NEC in extremely preterm neonates. Level of evidence III. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to determine whether a correlation exists between the sonographic findings and the clinical outcomes, defined as surgery or death, in neonates with radiographically and/or histopathologically confirmed necrotizing enterocolitis (NEC). Material and Methods In this retrospective study, the case notes of 58 patients admitted to Karolinska University Hospital, Stockholm, Sweden, with radiographically confirmed NEC from September 2010 to August 2013, were reviewed. We included all newborns who underwent both plain abdominal radiographs and an abdominal ultrasound on the same day. The images were reviewed retrospectively. Patients' characteristics, clinical data, and histopathological data were recorded from the case notes. We excluded newborns who developed free gas before surgery. Abdominal ultrasound images were reviewed for free intraperitoneal gas, peritoneal fluid, pneumatosis intestinalis, portal gas, bowel vascularity, bowel wall thickness, and peristalsis. We correlated the sonographic features with the clinical outcomes; defined as the need for surgery or death. Results Overall, 25 neonates were included. Out of these, 11 patients underwent surgery and 5 patients died. The sonographic finding of complex fluid collection was statistically significant, predicting severe NEC that needed surgery. No other sonographic features were related to the need for surgery or death. Conclusion Complex fluid collection shown with abdominal ultrasound appears to be strongly correlated to the need for surgery in newborn infants with severe NEC. [ABSTRACT FROM AUTHOR]