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

Volvulus is an emergency condition, but data on its prevalence and outcome in preterm infants are scarce. We analysed data from the German Neonatal Network and conducted structured literature review 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. Nine relevant publications involving 97 preterm infants with volvulus were identified, revealing a wide range of postnatal onset and a mortality rate of 15.2%. The prevalence of volvulus was 123/23,652 (0.5%) according to the German Neonatal Network, which was significantly lower than the prevalence of necrotising enterocolitis 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 surgery for 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 greater in the necrotising enterocolitis group (24%) than in the volvulus group (15%). Volvulus occurs in five out of 1,000 very-low-birth-weight infants, particularly in those requiring immediate surgery after 20 days of age. A prospective multicentre clinical cohort study.