Postoperative Outcomes of Extremely Low Birth-Weight Infants With Necrotizing Enterocolitis or Isolated Intestinal Perforation (original) (raw)
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Journal of the American College of Surgeons, 2013
BACKGROUND: Necrotizing enterocolitis (NEC) is a leading cause of death in very low birth weight (VLBW) neonates. The overall mortality of NEC is well documented. However, those requiring surgery appear to have increased mortality compared with those managed medically. The objective of this study was to establish national birth-weight-based benchmarks for the mortality of surgical NEC and describe the use and mortality of laparotomy vs peritoneal drainage. STUDY DESIGN: There were 655 US centers that prospectively evaluated 188,703 VLBW neonates (401 to 1,500 g) between 2006 and 2010. Survival was defined as living in-hospital at 1-year or hospital discharge.
Annals of Surgery, 2021
; investigation; writing review and editing Henry Rice, MD-conceptualization; investigation; writing review and editing Arlet G. Kurkchubasche, MD-conceptualization; investigation; writing review and editing Karl Sylvester, MD-conceptualization; investigation; writing review and editing James C. Y. Dunn, MD PhD-conceptualization; investigation; writing review and editing Troy A. Markel, MD-investigation; writing review and editing Diana L. Diesen, MD-investigation; writing review and editing Amina M. Bhatia, MD MS-conceptualization; investigation; writing review and editing Alan Flake, MD-conceptualization; investigation; writing review and editing Walter J. Chwals, MD-conceptualization; investigation; writing review and editing Rebeccah Brown, MD-conceptualization; investigation; writing review and editing Kathryn D. Bass, MD MBA-conceptualization; investigation; writing review and editing Shawn D. St. Peter, MD-conceptualization; investigation; writing review and editing Christina M. Shanti, MD-conceptualization; investigation; writing review and editing Walter Pegoli, Jr, MD-conceptualization; investigation; writing review and editing David Skarda, MD-conceptualization; investigation; writing review and editing Joel Shilyansky, MD-conceptualization; investigation; writing review and editing David G. Lemon, MD-conceptualization; investigation; writing review and editing Ricardo A. Mosquera, MD MS-investigation; data acquisition; writing review and editing Myriam Peralta-Carcelen, MD MPH-investigation; data acquisition; writing review and editing Ricki F.
Journal of Pediatric Surgery, 2000
Background/Purpose: Peritoneal drainage is a temporizing procedure for infants with extremely low birth weight (ELBW) who have perforated necrotizing enterocolitis (NEC). ''Salvage'' laparotomy is advocated when patients worsen after drainage. Some patients have survived with intact gastrointestinal functional after drainage alone. The purpose of this study is to determine if these salvage laparotomies are beneficial. Methods: The authors reviewed the records of ELBW infants treated at Stanford University with perforated NEC from 1993 through 1998. Data collected included demographic makeup, type of operation, survival rate, postoperative complications, length of stay (LOS), and cost. Results: The authors treated 26 patients, 9 with laparotomy and 17 with peritoneal drainage. The peritoneal drainage group had lower birth weight and more comorbid conditions. Survival rate was similar between laparotomy and drainage: 55.6% versus 41.2%. Four patients in the drainage group underwent salvage laparotomy for perceived clinical deterioration. All of these patients died. The clinical status of patients who had salvage laparotomy and died was similar to those who did not and lived. Seven of 13 patients treated with drainage followed only by supportive care and antibiotics survived. Cost and LOS for patients undergoing salvage laparotomy were much greater than for nonsurviving patients undergoing only peritoneal drainage: 84 Ϯ 20 days and 660,000comparedwith34Ϯ11daysand660,000 compared with 34 Ϯ 11 days and 660,000comparedwith34Ϯ11daysand306,000. Conclusions: Both primary peritoneal drainage and laparotomy should be considered primary therapy for perforated NEC. Patients undergoing peritoneal drainage typically experience clinical deterioration after operation. In this limited experience, salvage laparotomy did not appear beneficial.
La Clinica terapeutica, 2017
Survival of preterm infants have dramatically improved over the last decades. Nonetheless, infants born preterm remain vulnerable to many complications, including necrotizing enterocolitis (NEC). The severity of the disease and the mortality rate are directly correlated with decreasing gestational age and birth weight. Despite surgical treatment mortality rate remains very high in extremely premature infants, especially in newborns at the lowest limit of viability. Survival of infants of birth weight (BW) below 750 g has been increasingly reported in recent years, however the overall mortality in extremely low "BW" infants (ELBW) requiring surgery for NEC has not decreased over the past years. We describe our experience with a male preterm infant who survived after an ileostomy procedure for Bell stage II NEC, with improving neuromotor skills at 2 years follow up. Although standard indication to surgery is Bell stage III, in our case the choice of minimal laparotomy, explo...
Predictive Factors for Surgery in Preterm Neonates with Necrotizing Enterocolitis: A Retrospective Cohort Study, 2022
N ecrotizing enterocolitis (NEC) is a serious neonatal condition. [1] In the absence of reliable epidemiologic data, the true incidence of NEC remains to be unknown. This incidence varies from 2% to 17% in preterm infants. [2] The etiopathogenesis of NEC is complex, and several factors have been incriminated in the pathogenesis of this condition, including genetic factors, highly immune-reactive intestinal mucosa, abnormal microbial colonization, and the immaturity of the intestine. [3,4] During the last three decades, there has been significant progress in neonatal intensive care with an increased incidence of prematurity. This has led to an increase in the incidence of NEC. [2] Many therapeutic strategies have been developed to prevent NEC, including breastfeeding, prenatal glucocorticoid administration, and probiotic supplementation. However, this condition is still common in neonatal intensive care units. [5-8] Many researchers have studied the correlation between perinatal, clinical, and laboratory factors and the clinical deterioration of neonates with NEC, ultimately requiring surgical management. However, these factors did not find widespread use due to conflicting results. [9-12] Moreover, most studies regarding NEC management are from high-income countries. Our study aimed to assess predictive factors for surgical treatment in preterm neonates with NEC in a Tunisian center. Objectives: Necrotizing enterocolitis (NEC) is a severe neonatal condition. This study aimed to assess predictive factors for surgical treatment in preterm neonates with NEC in a Tunisian center. Methods: We present a retrospective study including all neonates treated for NEC between January 01, 2010 and March 31, 2022. Results: Within the study period, 102 patients were included, with an overall survival of 47%. Most of our patients were male (64.7%), with low birth weight or less (100%), 5-min Apgar score ≥8 (79.4%), and Bell's stage II (66.7%). Multivariate logistic analyses demonstrated that gestational age <30 weeks (p=0.002, odds ratio [OR]=4.544), birth weight <1000 g (p=0.001, OR=5.750), NEC onset <7 days (p<0.001, OR=5.667), not being breastfed (p=0.019, OR=3.026), and C-reactive protein level >20 mg/L (p=0.020, OR=2.942) were associated with the need for surgical treatment in neonates with NEC. Conclusion: Our findings would be helpful in refining treatment modalities for better disease outcomes.
Short-term outcomes for preterm infants with surgical necrotizing enterocolitis
Journal of perinatology : official journal of the California Perinatal Association, 2014
To characterize the population and short-term outcomes in preterm infants with surgical necrotizing enterocolitis (NEC). Preterm infants with surgical NEC were identified from 27 hospitals over 3 years using the Children's Hospitals Neonatal Database; infants with gastroschisis, volvulus, major congenital heart disease or surgical NEC that resolved prior to referral were excluded. Patient characteristics and pre-discharge morbidities were stratified by gestational age (<28 vs 28(0/7) to 36(6/7) weeks' gestation). Of the 753 eligible infants, 60% were born at <28 weeks' gestation. The median age at referral was 14 days; only 2 infants were inborn. Male gender (61%) was overrepresented, whereas antenatal steroid exposure was low (46%). Although only 11% had NEC totalis, hospital mortality (<28 weeks' gestation: 41%; 28(0/7) to 36(6/7) weeks' gestation: 32%, P=0.02), short bowel syndrome (SBS)/intestinal failure (IF) (20% vs 26%, P=0.06) and the composite o...