Volvulus in very-low-birth-weight preterm infants enrolled in the German Neonatal Network: Prevalence, mortality, and outcome

Background: Volvulus is an emergency condition, but data on its prevalence and outcome in preterm infants are scarce. Methods: We analyseddata from the German Neonatal Network and conducted a PubMed literature search on the primary hospital stay of very-low-birth-weight infants who underwent surgery for volvulus. Infants who underwent surgery for focal intestinal perforation and/or necrotising enterocolitis served as a comparison group. Results: Nine relevant publications involving 102 preterm infants with volvulus were identified, revealinga wide range of postnatal onset and a mortality rate of 10.7%. The prevalence of volvulus was 123/23,652 (0.5%) according to the German Neonatal Network,which was significantly lower than the prevalence of necrotisingenterocolitis and/or focal intestinal perforation. The volvulus group had a significantly higher proportion of female premature infants than the groups with necrotising enterocolitis or focal intestinal perforation. Most operations for volvulus were performed after the 20th day of life. Preterm infants who underwent surgeryfor volvulus had significantly less intraventricular haemorrhage and faster feeding than did those with necrotising enterocolitis and/or focal intestinal perforation. Notably, however, perioperative mortality was highest in the volvulus group. Furthermore, mortality until discharge was significantly greaterin the necrotising enterocolitis group (24%) than in the volvulus group (15%). Conclusion: Volvulus occurs in five out of 1,000 very-low-birth-weight infants, particularly in those requiring immediate surgery after 20 days of age.