Neonatal acute appendicitis: a proposed algorithm for timely diagnosis

BackgroundNeonatal appendicitis (NA) is a rare disease with a high mortality. The diagnosis has never been reported preoperatively and is notoriously difficult to make.MethodsCharts since 1995 were retrospectively reviewed for discharge or death diagnoses of appendicitis in neonates younger than 28 days. We report 3 cases of NA seen at our institution during this period.ResultsAll 3 infants were previously well, born at term, and presented with signs consistent with abdominal sepsis. The first 2 diagnoses were not made until autopsy. The third case survived after having an urgent computed tomographic scan, exploratory laparotomy, and appendectomy.DiscussionThe literature summarizing common presenting features of NA is reviewed. We present an algorithm to guide the workup of these neonates to facilitate earlier diagnosis and potentially improve outcomes.