179 Incisional hernia after abdominal surgery in infants: A retrospective analysis of incidence and risk factors Chapter 7 of perioperative antibiotic administration, as a result of improper protocol adherence or even the absence of protocols [19]. Our data suggests that patients with a history of prematurity were more prone to develop an IH. We performed two sensitivity analyses to evaluate if this tendency was confounded by neonatal age at surgery or by the high risk diseases NEC and gastroschisis, since they entail high percentages of premature born infants [20]. In both analyses a history of prematurity remains a significant risk factor, supporting the idea that a history of prematurity itself is a significant risk factor. It could be that ex-premature infants experience impaired wound healing due to the fact that an underdevelopment of the dermis leads to physiological differences [20]. Or they could be more prone to wound infections due to an underdeveloped immune system [21]. These suggestions need further research before conclusions can be reached. A history of a stoma also increases the risk of IH development in infants. Stoma reversals in paediatric cases seem to increase the risk of wound infection, which could partly explain the increase in IH-risk [22]. Compared to adults, in which IH occurs after onethird of the stoma reversals, infants seem to be less at risk [23]. In adults obesity is an important risk factor, proven to increase the risk of IH fivefold [24]. Since this factor does not apply to infants, this might partly explain the difference. Contrary to earlier published results, we report that the age at operation is not a significant risk factor for IH [6]. We agree that younger patients have an increased risk of IH, but this is not related to the age at surgery but rather to other factors for each of the high risk diseases encountered in neonates and vice versa. NEC, intestinal atresia and gastroschisis are the predominant neonatal reasons for surgery in our cohort, whilst older infants were mainly operated because of PS, undescended testis or Hirschsprung’s disease. The categorical comparison of neonates to children aged up to 16 years, as previous studies have done, at first glance seems to show that the age at surgery is of significant importance to IH. We have overcome this issue by decreasing the age span, including only infants, as well as using a continuous outcome for age at operation. Additionally, midline incision, suture resorption speed, braided sutures and mode of suturing, and mechanical factors which are of significant importance in adult IH development, are not significant risk factors in infants. This follows findings from previous studies [6].
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