Growth, Health, and Development After Neonatal Gut Surgery: A Long-term

Follow-up
Amir Tejani, Bohdan Dobias, Bhim S. Nangia and R. Mahadevan
Pediatrics 1978;61;685

The online version of this article, along with updated information and services, is located on
the World Wide Web at:
http://pediatrics.aappublications.org/content/61/5/685

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 1978 by the American Academy of Pediatrics. All rights reserved. Print
ISSN: 0031-4005. Online ISSN: 1098-4275.

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Growth, Health, and Development

Surgery: A Long-term Follow-up
Amir

Tejani,

From

the

Medical

M.D.,

Department

Center,

Bohdan

Dobias,

of Pediatrics,
Brooklyn

Growth
and development
data on 19 children
who survived
gut surgery
in the immediate
newborn
period
are presented.
The
follow-up
period
ranges
from
seven
months
to seven years six months,
with a mean of three years
eight months.
Neonates
who undergo
gut resection
are at a
higher risk for delay in height
and weight
gain compared
to
those who have gut surgery
without
resection.
Six of the 12
children
who had gut resection
showed
delay in height
gain
and seven showed
delay in weight
gain. Of the seven children
who had gut surgery
but no resection,
only one showed
delay
in height
and weight gain after the age of 1 year. An
individual
approach
and careful
serial follow-ups
are recommended
for all children
undergoing
gut resection
in the
newborn
period.
Of the eight children
who had psychometric
testing
in the gut-resected
group,
only
two
are
normal.
Three
of the four older children
in this group
show
signs of perceptuomotor
defects,
suggesting
the need
for
subtesting
such
children
at
about
6 years
of age so that
ABSTRACT.

remedial

schooling
s-urgery,

help,
begins.

growth

if necessary,
may be provided
Pediatrics
61:685-693,
1978,
and development.

when formal
neonatal
gut

Improved
surgical
and anesthetic
techniques
have made gut surgery
on the newborn
relatively
less
hazardous.
With
increasing
survival,
it
becomes
necessary
to evaluate
the quality
of life
that these survivors
lead. There
are very few such
studies
and our study
is an attempt
to assess the
quality
of life following
neonatal
gut surgery.

PATIENTS

M.D.,

The Methodist

cians.

S. Nangia,

Hospital

and weight
from clinic

and

data
charts

Height

and

M.D.,

State

and R. Mahadevan,

University

for each
or from
weight

Gut

of

New

York,

M.D.

Downstate

child
were
obtained
files of private
physiat various

ages

for

each

child were plotted

on continuous
boy-girl
growth
charts.
In 15 of 19 children,
at least
the last
measurement
of height
and weight
was made
personally
by the senior
author.
Eleven
of the 19
children
were available
for a psychometric
evaluation.
For children
up to 4 years of age, the Denver
Developmental
Scale2
and the Vineland
Social
Maturity
Scale3 were used. For children
between
4 and 6 years,
the Wechsler
Preschool
and
Primary
Scale
of Intelligence4
was
used,
and
children
over 6 years were
given
(1) the Bender
Visual Motor
Gestalt
Test,5 (2) the Draw
A Person
Test,#{176}
and (3) the Wechsler
Intelligence
Test for
Children-Revised.7
The psychometric
evaluation
was carried
out independently
by a team
of
psychologists.
For comparison,
the children
were divided
into
two groups.
Group
A consists
of 12 children
who
underwent
varying
degrees
of gut resection,
and
group
B consists
of seven
children
who
had
derotation
or closure
of perforation
or an anastomotic
procedure
done
without
any gut being
resected.

AND METHODS

Records
of newborn
babies
undergoing
surgery
in the immediate
neonatal
period
for intestinal
obstruction
or herniation
for the years
1968 to
1975
were
reviewed.
Out
of a total
of 19,174
infants
delivered,
there
were
29 such patients,
seven of whom
died in the immediate
postoperalive period.
Of the 22 survivors,
no follow-up
information
was available
in three. The remaining
19 have
been
followed
up for periods
ranging
from seven months
to seven years six months,
with
a mean
of three
years
eight
months.
The height

Bhim

After Neonatal

RESULTS
Table
I shows
the diagnosis,
type
of surgery,
and remaining
length
of intestine
in all of the
patients.
Table
II shows hyperalimentation,
intrahospital
weight
gain, and duration
of hospitaliza-

January
18; revision
accepted
for publication
September
15, 1977.
ADDRESS
FOR REPRINTS:
(A.T.) Department
of Pediatiics,
The Methodist
Hospital,
506 Sixth Street, Brooklyn,
NY

Received

11215.

PEDIATRICS

Vol.

61

No.

5 May

1978

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685

TABLE
DiAGNosIs,

Patient

SURGERY,

Diagnosis

AND

REMAINING

LENGTH

OF INTESTINE

Surgery

Small Bowel
Remaining

Colon
Remaining

Group

Al

Malrotation

A2

Volvulus

with

A3

Omphalocele
ing colon

A4

Multiple

volvulus

of terminal

of ileum

15 cm

ileum

125

with atresia
of ascend& ileocecal
valve

ileal

of gangrenous

cm

ileum

of terminal

resected

12 cm of terminal
ileum
right hemicolectomy

atresia

35 cm

and

resected

ileum

atretic

resected

areas

&

of ileum

180

cm

120

cm

Intact

240

cm

Transverse
cending

Intact

75 cm

& descolon

Intact

resected

A5

Necrotizing

A6

Jejunal

A7

Supralevator

enterocolitis

20 cm of ileum
& transverse

atresia

30 cm
type

of

anorectal

resected
colectomy

of jejunum

Sigmoid

colon

& ascending

220

resected

cm

Sigmoid

100 cm

resected

& rectum

Intact

Intact

&

Ascending

anomaly

transverse

A8

Hirschsprungs

A9

Omphalocele

disease

Transverse
resected
6-7

cm

&

colon

& splenic

of terminal

ascending

ileum
colon

Omphalocele

10 cm of small

bowel

All

Ileal

15 cm

& atretic

of ileum

& cecum

Not

Intact

Ascending
& sigmoid colon

measured

Transverse

resected

AlO

atresia

flexure

scending

resected

Not

colon

measured

& decolon

Intact

areas

130

cm

Intact

resected

200

cm

Intact

resected

A12
Group
Bi

Necrotizing

enterocolitis

Mairotation

of bowel

Malrotation

Malrotation

of bowel

Lysis

45 cm

of proximal

ileum

B2

junal

of stomach

B3

Large

B4

Malrotation
annular

perforation

with duodenal
pancreas

B5

Duodenal

atresia

& release

of duodenoje-

Intact

Intact

Intact

Intact

Intact

Intact

Intact

Intact

Intact

Intact

flexure

Primary
stenosis;

corrected

of bands
closure

of perforation

Lysis of adhesions;
my
Retrocolic

duodenojejunosto-

side-to-side

duodenojejunos-

tomy

B6

Duodenal

atresia

Lysis

of bands

& duodenojejunostomy

Intact

Intact

B7

Duodenal

atresia

Lysis

of bands

& duodenojejunostomy

Intact

Intact

lion

in

all

of the

patients.

Figures

1 and

of his

2 show

the height
curves
and Figures
3 and 4 show the
weight
curves
of children
in group
A. The growth
of these

curves

in

two

simply

children

in group

figures
each
rather
to achieve
clarity.
Figures
sets

of

present
height
A9) and their

and weight
respective

Figures

8 show

children

7 and

in group

of two
healthy

height

and

A are

displayed

than
one set,
5 and 6 show
patients
identical

weight

(Al and
twins.

curves

of

B.

his

subsequent

present

height

height

at

were

fifth percentile.
When
two of the patients
A9 (Figs.
5 and 6), were
identical
twins who did not
showed

delay

in height

not

3#{189}
years

gain.

available,

is well

below

but
the

in this group,
Al and
compared
with
their
undergo
In

surgery,
group

B (Fig.

both
7),

of the seven children,

only one (B5) showed
delay
in height
gain. The other
six had adequate
growth
velocity
to be above
the fifth percentile
by the
age

of

1 year.

Height
Of 12 children
in group
show delay in height
growth
and A8). Patient
A4, though
percentile
the age

686

in Figure
of 1 #{189}
years,

A (Figs.
1 and 2), six
(Al, A2, A4, A6, A7,
shown

1, was unable
and accurate

near

the

95th

to stand
after
measurements

Weight
Of the 12 children
in group
A (Figs.
3 and 4),
seven children
showed
delay
in weight
gain (Al,
A2, A4, A6, A7, A8, and Al2).
When
the two
patients,
Al and A9, were
compared
with
their

NEONATAL
GUT SURGERY
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TABLE
HYPEBALIMENTATION,

Patient

Group
Al

Gestational
Age (wk)

DURATION

OF HoSPITALIzrIoN,

Birth
Weight
(gm)

Lowest
Weight
(gin)

1.270

1,140

AND

WEIGHT

INTRAHOSPITAL

Weight
on
Discharge
(gm)

Intrahospital
Weight
Gain
(gm)

2,280

1,010

Hospital
Stay
(Days)

GAIN

Hyperalimentation

A
30

94

TPN#{176}through

cen-

tral venous catheter for 7 days

A2

Term

2,890

2,350

2,440

A3

38

2,620

2,450

2,940

A4

40

3,070

2,470

2,640

-430

16

Nil

A5

38

4,980

4,430

4,670

-310

28

Nil

A6

37

2,230

2,100

2,890

A7

38

3,330

2,850

3,300

A8

39

3,250

2,620

2,920

35

Nil

A9

34

2,290

2,120

2,330

40

12

TPN

AlO

40

3,010

2,800

3,310

300

27

Nil

All

28-30

1,140

1,100

2,980

1,840

A12

39

3,2.00

3,020

3,450

250

Group

-450
320

660
-30

-330

12

Nil

25

Nil

38

Nil

13

Nil

120

42

for 6 days

TPN

for 15 days

TPN

for 28 days

Bi

Term

2,390

2,200

2,490

100

16

Nil

B2

40

3,150

3,050

3,330

180

16

TPN

for 6 days

B3

38

2,390

2,320

2,500

110

15

TPN

for 4 days

B4

38

2,650

2,500

3,060

410

31

Nil

B5

40

2,700

2,440

2,700

43

Nil

B6

32

3,500

3,400

3,980

480

38

Nil

B7

30-32

1,800

1,610

2,620

820

57

TPN

#{176}TPN =

total

parenteral

identical
twins
showed
delay
dren in group
weight
gain.

who did not undergo

surgery,
both
in weight
gain.
Of the seven
chilB, only one (B5) showed
delay
in

In group A, two children

(Al and A2) showed
evidence
of malabsorption
by fat balance
and
vitamin
absorption
studies.
Two other children
in
group A (A6 and A12) have pale, frequent
stools
but no persistent
diarrhea.
Malabsorption
studies
have not been
done
on them
because
they are
only
1 year
old. In two children
(A7 and A8) in
whom
colonic
resection
was done,
there
is no
clinical
evidence
of malabsorption.
In two other
cases, permission
to do malabsorption
studies
was
denied:
patient
A4, who shows
marked
mental
retardation
due to birth injury
and hypoxia,
and
patient
B5, who is a mongoloid
child.
Mortality
of the

patients

for 21 days

nutrition.

Malabsorption

One

in this

group,

A5,

was

large baby who developed

necrotizing
enterocolitis soon after birth. He recovered
after ileal and
colonic
resection,
and gained
weight
and height
satisfactorily.
At age 8 months,
he developed
recurrent
necrotizing
enterocolitis,
had multiple
resections
of the gut, and died 45 days later due to
malnutrition
and sepsis
despite
total
parenteral
alimentation.
Other

Morbidity

One child, All,

was found to have hydrocephalus at age 10 months.
She was a preterm
averagefor-gestational-age
baby who required
prolonged
parenteral

hyperalimentation

following

ileal

resection.
The
hydrocephalus
appears
to be
related
to the use of jugular
venous
catheter
inserted
for total parenteral
alimentation.
Patient
A2 illustrates
some
of the problems
of
children
undergoing
gut resection.
She had 125
cm of ileum removed
at birth for ileal atresia.
By
the age of 6 months,
her height
growth
had
decelerated
enough
to make her below
the fifth

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687

45

40

35
(I)

hi
I
hi
I

25

HEIGHT

25

20
A7MC
A8KJ

HEK3HT

A9CC

AlSR.-#{149}A4JE-----A2WGA5GR

-MONTHS

percentile

curves

for
gain

fifth

of first

height,
had

and

six children

by

decelerated

percentile.

Fic.

YEARS-

1. Height

weight

adhesions

in group

1 year

of

6, when

she

A.

age,

to hovering

At age

between

adherent

growth
is still

segments

bands

spurt
below

Table
children

and
the fifth

her

around
was

below

(A6

and

to

though

Lysis

put

her

on

height

results
available

of the

obtained
on all
for the study.

12 children

one

were

11
In

available

is profoundly
to test him
was
too young
to be

AlO).

Of the
functioning

eight children
at a moderate

688

NEONATAL

2. Height

curves

Subtesting
Bender

percentile.

for study,
one
died
(A5),
retarded
(A4) and
permission
denied,
and two are considered
tested

bowel.

her

Functioning

III shows
who
were
A, eight

of the

has enabled
gain
weight,

Intellectual

group

A12LJ

YEARS
of second

six children

in group

A.

dation,
three
show signs of perceptuomotor
difficulties,
one has deficient
language
skills,
one is
functioning
at the lower
range
of normal
with
motor
difficulties,
and two are considered
normal
with full-scale
IQs of 109 and 115.
In group
B, only three
children
were available
for testing.
Of the
remaining
four,
one
was
considered
too young
for testing,
two have moved
out of the area, and the fourth
one is a mongoloid
child (permission
to test him was denied).
All of
the three
tested
children
in this group
are functioning
at above-average
range.

the fifth percentile

for height
and weight,
she was
restudied
and persistent
malabsorption
was diagnosed.
Exploratory
laparotomy
revealed
marked
of

A1OJR
All MI---

4
MONTHS

A6GM

A3Dr

the

RESECTED

----

Al-6

20

FIG.

RESECTED
A7-12

tested
in group
A, one is
range
of mental
retar-

and

of Older Children
With
Draw A Person Tests

Bender
Visual Motor Gestalt
Test. The ability
to
copy
geometric
designs
reflects
maturity
of
visual-motor
perception.
Up to the age of 11
years, errors
indicate
either
perceptual
immaturity or a defect
in neurological
functioning.
Beyond
the age of 1 1 years,
significant
errors
reflect
impaired
neurological
functioning.5
Of the four children
in group
A who were given
the Bender
test, three made multiple
errors
on the
nine
Bender
drawings
and
showed
a developmental
age less than the chronological
age.

GUT SURGERY

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40

30

30

(1)

WEIGHT

10

A1-6

RESECTED
A 7-12

A4JE

A7 MC
A8KJ

A5GR
A6GM

AlO

JR

All

MT---

A9CCAl2LJ

0
-

3. Weight

FIG.

MONTHS
curves

YEARS

).C

of the

first

six children

in group

A.

4. Weight

FIG.

BOYS
11114

NAME
IN

MONTHS
curves

YEARS

>

of second

six children

in group

A.

GIRLS

DATE

SEEThE DATE

CM

IN

.I

170

CM

70

CM

IN

I 70
S

S
160

l40

0
60

40

55

SO

I SO

140

40

130

130

40
SO

55

SO

SO

140

55

130
SO

SO

AG

120

IN

KG

LI

45

SO

I 10

AGO

120

YE LEO

LI

45

OS

KG

SO

hO
S

40

40

140

100

60
35

E30

90

120

$0

40
35

55

130

I0

120

55

30

30

So

70

70

AGE
IN

90

KG

IN

100

LI

90

90

40

45

KG.

40

40

30

35

70

70

40

40

SO

SO

40

40

30

30

20

of patient
(T).

twin

Al

(P) and

$0

40

35

30

30
40

25

25
SO

20

20
40

15

S
30

30
10

20

height and weight

healthy
identical

I0

40
IS

10

90

SO
20

is

90

40
20

25

100

LI.

70

30

30

5. Present

YEARS

00

#{149}0
35

FIG.

SO

AGE

YEAtS

his

10

FIG.

20

6. Present

height
and weight
healthy
identical

of patient
twin

A9 (P) and

her

(T).

ARTICLES

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689

40

(I)

hi

WEIGHT
UNRESECTED

#{149}1

25

Bi
B2
B3

#{149}39

HEIGHT

HA.
J N.
CM

Bl-7
B4JF
B5JK
B6 ER
B 7 J R

UNRESECTED

B1HAB2JN---

Bl-7
B4JFB5JK--

B3CM----

B6

2 4 6
--MONTHS

E.R.---

Fic.

8. Weight

8 10

11/2

---->-

curves

of children

3 4
YEARS--->

in group

B.

B 7 J R.......
survivors

15
MONTHS

FIG.

7. Height

curves

normal
The

YEARS-

:..<

of children

in group

B.

the

three
limits.
average

neonate

preterm
160
to
A

Person

measure

Draw

of

developmental

one

to another,

part

Test.
and

This
test
maturity,
awareness

provides
relation
of the

body

years
length

after

resection

of the

jejunum

is approximately

observed
that
in cases
total
length
of jejunum

in

by accurate

measurements

ileum

cm.17

length
and

of intestinal
and ileum

within

and

248

neonate,
intestinal
240
cm.18
Santuli

a
of

was

in

In

varies
Blanc19

the

from
have

atresia,
as determined

of resected

the

specimens

space.
The four older
children
in group
A were
given
this test, and three
of them
scored
poorly,
showing
a developmental
age
far below
the

and of the remaining

intestine
at necropsy
is often
a great
deal
less
than
that
of the
intestine
in
comparatively
normal
newborn
infants.
Young

chronological

and her
two of

children
test.

age.

who

These

were

showed

defects

the

same

on

the

three

Bender

and
large
found
motor
reported

development.8
number

of children
deal

with

than

subsequent

14

of

15

cases

it frequently

of

difficult

function
because
as normal.
In

intestinal
to

690

than
50%
the
clinical

NEONATAL

of

the
and

GUT

after

residual

growth

reviewing
resection,

assess

growth

most
children
his review,
most

vors had body

weights
within
the
after
the
first year
of life.
Benson
study of ten patients
who underwent
more
that

undergoing
survival

normal
et

al.,16

resection

made

a similar

observation

in

their
cases
when
the
remaining
bowel
length
was measured
at surgery,
and Benson
and
his colleaguesl8
noted
that in many
cases
of atresia
the total
length
of functional
small
intestine
prior
to any resection
is 100 to 150 cm.
In our three
cases
of atresia
(A4, A6, and All),
the measured

DISCUSSION
Long-term
follow-ups
gut
resection
usually
massive
resection
rather

associates3

a
and

were
survi-

range
in

of

small
intestine,
observed
nutritional
status
of the

total
This

plus
expected
discrepancy

resected
for

bowel

the patients
is accounted

was

less

age
for by

than

the

and
weight.
intrauterine

intestinal
loss secondary
to vascular
accidents,
resulting
in arrest
of growth
of the bowel.131819
The intrauterine
reduction
in the total length
of
functional
small
bowel
may also be responsible
for the persistence
of growth
failure
in two of our
three
patients
with atresia
(A4 and A6).
When
a large portion
of the gut is resected,
the
subsequent

absorption

is probably

carried

SURGERY

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out

by

TABLE
PSYCHOMETRIC

Patient

Group

Chronolog
Age

ical

Full

Scale
IQ

EVALUATION

Verbal
IQ

Performa
IQ

III

OF CHILDREN

nce

Social Age
(yt)

IN GROUPS

Social
Quotient

A AND

Remarks

Al

4-4

A2

7-10

A3

7-3

Bright

84

85

86

Psychometric

101

105

98

Psychometric

115

tor

normal
perceptual

6-1 1

93

105

84

deficit

A8

6-11

109

A9

3-10

111

106

3-4

83

No

Functions

language
All

4-1

49

evidence

perceptual

evidence
organicity

Moderate

of

visual-mo-

deficit

Psychometric
tor

intelligence

of visual-mo-

evidence

tor perceptual
A7

of

range

evidence

of visual-mo-

deficit

of perceptual
in all

normally

skills
range

deficit

are

areas,
delayed

of mental

or
but

retarda-

tion

Al2

1-1

11 mo

84

Functioning

within
low
with difficulties
in motor
sphere
range

Group

average
specifically

Bl

1-8

1-9

118

Functioning

at above

average

range

B2

3-1

4-7

141

Functioning

at above

average

range

136

2-6

2-9

1 16

Functioning

at above

average

range

the increase
in caliber
as well
as longitudinal
growth
of the remaining
intestine.1620
Rickham2#{176}
has shown
in animal
experiments
that significant
compensatory
longitudinal
growth
did occur
in
some
of the piglets
subjected
to extensive
gut
resection.
However,
this compensatory
growth
bore no relation
to the subsequent
development
of the piglet.
Adequate
growth
can occur
in the
presence
of persistent
marked
steatorrhea,21
and
the exact
point
in the growth
period
when
the
intestine
regains
its capability
for normal
fat
utilization
is unknown.16
Hence,
the criteria
for
following
up children
with
gut resection
should
be
serial
growth
measurements
rather
than
evidence
of steatorrhea.
The
role
of total
parenteral
nutrition
in
allowing
growth
and development
in neonates
undergoing
gut surgery
has been
documented.22
Table
II shows
that
all those
neonates
who
received
total
parenteral
nutrition
exhibited
intrahospital
weight
gain. On the other hand,
five
of the eight
children
in group
A who
did not
receive
total
parenteral
nutrition
showed
loss of
weight
during
the hospital
stay, and four of these
five children
(A2, A4, A7, and A8) continue
to
show
failure
in growth
for both
height
and
weight.
Total
parenteral
nutrition
could
not be
carried
out in the majority
of these cases because
the technique
was
then
not
widely
available

and
1969).
Though
the
numbers
small,
they
suggest
that
hyperalicarried
out in the immediate
postsurgical period may make an important
difference
in
the subsequent
growth
pattern.
The observation
that one of our patients
(Al) is
below
the fifth percentile
for height
and weight
four years after resection
even when
only 15.0 cm
of ileum was resected
and that two other
children
(A7 and A8) are also below
the fifth percentile
for
height
and weight
when
a portion
of the large gut
was resected
suggests
that an individual
approach
is necessary
for all children
undergoing
gut resection irrespective
of the length
or the anatomical
portion
of the gut removed.
On the basis that a
surgically
correctable
lesion (intestinal
adhesions)
was found
in another
patient
at age 6 years (A2),
we also feel that children
undergoing
intestinal
resection
should
be followed
up for periods
longer
than one to three years.
In contrast,
children
who
have gut surgery
but no resection
seem to achieve
adequate
height
and weight
gain by 1 year
of
age.
The
ultimate
height
achieved
by children
undergoing
major
intestinal
resection
may
be
slightly
reduced.
Valman,2
after following
up 12
such children
from 3 to 16 years,
observed
that
the patients
tend to be shorter
than their siblings
and that there
is a slight
reduction
in the final
(years

involved
mentation

1968
are

ARTICLES

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691

height

expected.

control

(an

In

our

identical

study,

twin)

when

was

an

ideal

available,

as

cases
Al and A9, we found
the patient
shorter
and lighter
compared
to the healthy
even though
the length
of the gut resected
not

if
in

in early
mental

suggestion

that

critical

phase

followed
of brain

cells.25.26

temporary
in

man

as

by a permanent

We

observed

retardation

well

in

animals

in the number

using

a single

moderate

the

range

child

with

4.

param-

of

mental

scoring
the

shunting,
but the
at a 2-year-old

of the

Vineland

youngest
Social

child

Vineland

and

child
at the
level.
The

in group

Maturity

a neurodevelopmental
culty
of interpreting

Scale

Bailey

6.
7.

when

8.

9.

age
low

A (Al2)

on

10.

to the diffisuch as the

11.

may

lag or point
results
of tests

the

5.

hydrocephalus

(All).
Like other
suspected
cases of hydrocephalus as a complication
of total
parenteral
nutrition,28 this hydrocephalus
has arrested
itself
and
did not require
of 4 is functioning

3.

is

Person
Test-in
eight
children
resection
of the ileum,
found
mental
retardation
to be no
the normal
population.

a
in

2.

permaalso

during

as

reduction

Valman,27

eter-The
Draw
A
who
had neonatal
the
frequency
of
higher
than
that
in

to cause
There
is

malnutrition

represent

given

to

very

young
infants.29
The
findings
of perceptuomotor
difficulties
in three
of the four older
children
in
group
A may be due to either
perceptual
immaturity
or a true
defect
in neurological
functioning.

12.

The

14.

development

complete

of

at

visual-motor

1 1 years,5

perception

and

retesting

is

of

can

(A2,

be

A3,

seen

and

a hospital

from

Table

II,

A7) showing

stay

shorter

the

three

perceptual
than

the

13.

these

children
at about
that time will be necessary
to
determine
whether
there
is a defect
in neurological functioning.
Developmental
disorders
can
follow
long
hospitalization
and maternal
deprivation,303
but,
as

15.

16.

deficits
child

had
(A8),

17.

18.

designed

19.

to

specifically
abilities

scholastic

skills.

measure
essential

Since

visual-motor

for

acquiring

Bender

in the

test

692

newborn

at about

period

6 years

NEONATAL

should

of age

basic

distortions

be

given

so that

IQ,33

we

20.

resection
the

remedial

their

Bender

help,

21.

following

infants.

extensive

I Pediatr

intestinal

resection

in

1972.
Benson
CD, Lloyd JR, Krabbenhoft
KL: The surgical
and metabolic
aspects
of massive
small
bowel
resection
in the newborn.
I Pediatr
Surg
2:227,
1967.
Benson
CD: Resection
and primary
anastomosis
of the
jejunum
and ileum
in the newborn.
Ann
Surg
142:478,
1956.

Benson CD, Lloyd JR, Smith

80:88,

DJ: Resection

and primary

anastomosis
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Pediatrics
26:265,
1960.
Santulli
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Blanc
WA:
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atresia
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Ann
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154:939,

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occur
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in

Jaworski
BA: A new continuous
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7:189,
1968.
Frankenberg
WK,
DOddS
JB: Denver
Developmental
Screening
Test.
Denver,
University
of Colorado
Medical
Center,
1969.
Doll EA: Vineland
Social Maturity
Scale. Circle
Pines,
Minnesota,
American
Guidance
Service
Inc.
1965.
Wechsler
D: Manual
for the Wechsler
Preschool
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Primary
Scale
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New
York,
The
Psychological
Corp,
1967.
Koppitz
E: The Bender
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Children.
New York, Grune
& Stratton,
1963.
Goodenough
FL: Measurement
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Wechsler
D: Wechsler
Intelligence
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1949.
Pilling
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SL: Massive
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intestine
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1957.
Lawler
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1962.
Wilkinson
AW, Hughes
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Br I Surg
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1963.
Moe PJ: Intestinal
function
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massive
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in a newborn.
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1964.
Kuffer
F: The
problem
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2:39, 1965.
Young
WF, Swain
VAJ, Pringle
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prognosis after major
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Bell MJ, Martin LW, Schubert
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Factors
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who shows no such deficit.

Recently,
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children,
Stoch and Smythe32
found
marked
disturbance
of
visual-motor
perception
in
17 of the 20 index
children
at ages 15 to 18 years. The Bender
test is
perceptual

early

AA,

outcome

children

fourth

provided

growth

seldom
been
measured
after
in infancy.
Severe
malnutri-

infancy
is believed
retardation.

be

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FOR DIARRHEA

1973.

IN INDIA

Today,
the great
majority
of cholera
patients
in the Infectious
Diseases
Hospital
in Calcutta,
India,
are successfully
being
treated
by oral rehydration.
This switch
over to oral fluid therapy,
which
in this hospital
now saves about
$50,000
every year in the cost of parenteral
fluids alone,
was the outcome
of a
study
carried
out by the Cholera
Research
Centre
of the Indian Council
of
Medical
Research,
in collaboration
with physicians
in the Infectious
Diseases
Hospital,
on the effectiveness
of this treatment
in cholera
patients
below
the
age of 5 years.
The Cholera
Research
Centre,
which
is also in Calcutta,
is a
WHO
Collaborating
Centre
for Reference
and Research
on Vibrios.
The study
showed
that 92% of patients
with moderate
to severe
dehydration
responded
well when
given
repeated
small
amounts
(25-30
ml, every
10-15
minutes),
rather
than
a single
large
volume
(250
ml),
of oral
fluid.
In this
way,
vomiting-which
occurred
invariably
when
the large volume
was given-was
found
not to cause
any problem.
The Centre
in the meantime
developed
a cheap
and simple
system
for
dispensing
the ingredients
(glucose-salts
mixture)
for oral rehydration
in sealed
polythene
packets
to facilitate
distribution.
Under
the name
of Chorosol,
the
packets-which
cost
about
$0.10
each-have
been
very
well
received
by
medical
and
paramedical
staff.
The
use
of Chorosol
in the
field,
in the
management
of cholera
epidemics,
has also been
very successful.
Noted
by Student
From

WHO

Chron

31:427,1977.

ARTICLES

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693

Growth, Health, and Development After Neonatal Gut Surgery: A Long-term

Follow-up
Amir Tejani, Bohdan Dobias, Bhim S. Nangia and R. Mahadevan
Pediatrics 1978;61;685
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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
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