Surgical Necrotizing Enterocolitis: Outcomes and Factors Affecting Mortality
Abstract
Background: Necrotizing Enterocolitis (NEC) remains a major cause of neonatal deaths worldwide. The morbidity and medical cost of these patients are still high. Objectives: The purpose of this study is to determine the overall mortality of surgical NEC, prognostic factors affecting mortality and to review the outcome of surgical NEC. Methods: Retrospective descriptive study of patients with the diagnosis of NEC at Queen Sirikit National Institute of Child Health (QSNICH) between 2011 and 2016 was conducted. Only the patients who had undergone surgical interventions (surgical NEC) were included into the study. The patients who received previous surgery from other hospitals were excluded. Data collection including patient demographics, clinical, laboratory and radiographic findings, surgical interventions, operative findings, complicationsand outcome were obtained. Statistical significance for all was defined as p-value less than 0.05. The significant prognostic factors were calculated for risk difference and number needed to harm. Results: Total of 40 newborns with surgicalNEC were enrolled into the study. The mortality rate was 30%. There were 7 prognostic factors which effect mortality, extremely preterm (GA<28 weeks), shock, coagulopathy (INR>1.5), extremely low birth weight (BW<1,000gm), anemia (Hct<30%), umbilical catheter insertion, and thrombocytopenia (platelet <50,000/mm3), respectively. The factors affecting the mortality rate were extremely preterm (GA<28 weeks) and shock. For long term outcomes of the 28 survivors, infectious complications (53.6%) were the most common complication followed by gastrointestinal complications (50%) and intestinal failure associated liver disease or IFALD (28.57%). Twenty-one percent developed recurrent NEC. The mortality rate of 33.3% was similar to primary NEC. Seven percent of survivors developed post NEC stricture which all required surgery. Conclusion: The recent outcome of surgical NEC at QSNICH has improved significantly with 70% survival rate. The factors affecting the mortality rate are extremely preterm and shock. These factors will help to predict the prognosis of patients with surgical NEC prior to surgical intervention. Hopefully, with aggressive measures starting from admission will help to reduce the mortality in the future.
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