title: Very low birth weight is an independent risk factor for emergency surgery in premature infants with inguinal hernia.
abstract: BACKGROUND
  Common surgical knowledge is that inguinal hernia repair in premature infants should be postponed until they reach a certain weight or age. Optimal management, however, is still under debate. The objective of this study was to collect evidence for the optimal management of inguinal hernia repair in premature infants.
  
  
  METHODS
  In the period between 2010 and 2013, data for all premature infants with inguinal hernia who underwent hernia correction within 3 months after birth in the Erasmus MC-Sophia Children's Hospital, Rotterdam were analyzed. Primary outcomes measures were the incidences of incarceration and subsequent emergency surgery. In a multivariate analysis, Cox proportional hazards model served to identify independent risk factors for incarceration requiring an emergency procedure.
  
  
  RESULTS
  A total of 142 premature infants were included in the analysis. Median follow-up was 28 months (range 15 to 39 months). Seventy-nine premature infants (55.6%) presented with a symptomatic inguinal hernia; emergency surgery was performed in 55.7%. Complications occurred in 27.3% of emergency operations vs 10.2% after elective repair; recurrences occurred in 13.6% vs 2.0%, respectively. Very low birth weight (≤1,500 g) was an independent risk factor for emergency surgery, with a hazard ratio of 2.7 in the Cox proportional hazards model.
  
  
  CONCLUSIONS
  More than half of premature infants with an inguinal hernia have incarceration. Those with very low birth weight have a 3-fold greater risk of requiring an emergency procedure than heavier premature infants. Emergency repair results in higher recurrence rates and more complications. Elective hernia repair is recommended, particularly in very low birth weight premature infants.
authors.affiliation: Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: b.degoede@erasmusmc.nl.
authors.forename: Barry
authors.initials: B
authors.lastname: de Goede
authors.affiliation: Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Verhelst
authors.affiliation: Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Bob J
authors.initials: BJ
authors.lastname: van Kempen
authors.affiliation: Department of Pediatrics, Maasstad Ziekenhuis, Rotterdam, The Netherlands.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Baartmans
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Hester R
authors.initials: HR
authors.lastname: Langeveld
authors.affiliation: Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Jens A
authors.initials: JA
authors.lastname: Halm
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Geert
authors.initials: G
authors.lastname: Kazemier
authors.affiliation: Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Johan F
authors.initials: JF
authors.lastname: Lange
authors.affiliation: Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Rene M H
authors.initials: RM
authors.lastname: Wijnen
mesh_terms: D000367:Age Factors; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000473:pathology / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000473:pathology / Q000601:surgery*; D019102:Infant, Very Low Birth Weight; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors