title: Hemorrhage is the most common cause of neonatal mortality in patients with sacrococcygeal teratoma.
abstract: BACKGROUND
  A small percentage of neonates with sacrococcygeal teratoma die shortly after birth from hemorrhagic complications. The incidence of and risk factors associated with hemorrhagic mortality are unknown. In this multicenter study we determined the incidence of early death in neonates born with SCT and evaluated potential risk factors for hemorrhagic mortality.
  
  
  METHODS
  235 children with SCT treated from 1970 to 2010 in the Netherlands were retrospectively included. The following candidate risk factors for hemorrhagic mortality were examined: sex, prematurity, Altman type, tumor volume, tumor histology, necessity of emergency operation and time of diagnosis.
  
  
  RESULTS
  Eighteen patients (7.7%) died at a median age of 163.5days (range 1.7-973days). Nine patients died of a malignancy. Nine others (3.8%) died postnatally (age 1-27days), six even within two days after birth. In seven of these nine patients death was related to tumor-hemorrhage and/or circulatory failure. Risk factors for hemorrhagic mortality were prematurity, tumor volume>1000cm3and performance of an emergency operation.
  
  
  CONCLUSIONS
  Hemorrhagic mortality of neonates with SCT is relatively high (3.8%) representing almost 70% of the overall mortality in the neonatal period. High-output cardiac failure, internal tumor hemorrhage and perioperative bleeding were the most common causes of early death and were all strongly associated with larger tumor sizes.
  II (Retrospective study).
authors: Department of Surgery-Maastricht University Medical Centre, Maastricht, the Netherlands.
authors: Marijke E B
authors: ME
authors: Kremer
authors: Department of Surgery-Maastricht University Medical Centre, Maastricht, the Netherlands.
authors: Lianne M
authors: LM
authors: Wellens
authors: Department of Surgery-Maastricht University Medical Centre, Maastricht, the Netherlands.
authors: Joep P M
authors: JP
authors: Derikx
authors: Department of Paediatric Surgery-University Medical Centre Groningen, Groningen, the Netherlands.
authors: Robertine
authors: R
authors: van Baren
authors: Department of Paediatric Surgery-Surgical Centre of Amsterdam (Emma Children's Hospital AMC and VU Medical Centre), Amsterdam, the Netherlands.
authors: Hugo A
authors: HA
authors: Heij
authors: Department of Paediatric Surgery-Radboud University Medical Centre, Nijmegen, the Netherlands.
authors: Marc H W A
authors: MH
authors: Wijnen
authors: Department of Paediatric Surgery-Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands.
authors: René M H
authors: RM
authors: Wijnen
authors: Department of Paediatric Surgery-Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors: David C
authors: DC
authors: van der Zee
authors: Department of Surgery-Maastricht University Medical Centre, Maastricht, the Netherlands. Electronic address: e.vanheurn@amc.uva.nl.
authors: L W Ernest
authors: LW
authors: van Heurn
mesh_terms: D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012445:Sacrococcygeal Region; D013120:Spinal Cord Neoplasms / Q000150:complications*; D013724:Teratoma / Q000601:surgery*
keywords: Germ cell tumor; Hemorrhagic death; Neonatal mortality; Sacrococcygeal teratoma