Surgical Necrotizing Enterocolitis: Outcomes and Factors Affecting Mortality

Authors

  • Fareda Kaseng Department of Surgery, Queen Sirikit National Institute of Child Health
  • Wannisa Poocharoen Department of Surgery, Queen Sirikit National Institute of Child Health
  • Rangsan Niramis Department of Surgery, Queen Sirikit National Institute of Child Health

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.

Downloads

Download data is not yet available.

References

O’Neill JA Jr. Neonatal Necrotizing Enterocolitis. Surg Clin North Am 1981;61:1013-22.

Khomnuan Y, Niramis R, Tongsin A, Anuntkosol M. Necrotizing Enterocolitis: An 8-year Experience with 60 Surgical Patients. Thai Pediatr J 2013;20:13-9.

Sankaran K, Puckett B, Lee DS, Seshia M, Boulton J, Qui Z, et al. Variations in incidence of necrotizing enterocolitis in Canadian neonatal intensive care units. J Pediatr Gastroenterol Nutr 2004;39:366-72.

Holman RC, Stoll BJ, Curns AT, Yorita KL, Steiner CA, Schonberger LB. Necrotising enterocolitis hospitalisations among neonates in the United States. Paediatr Perinat Epidemiol 2006;20:498-506.

Lin PW, Stoll BJ. Necrotising enterocolitis. Lancet 2006;368: 1271-83.

Holman RC, Stoll BJ, Clarke MJ, Glass RI. The epidemiology of necrotizing enterocolitis infant mortality in the United States. Am J Public Health 1997;87:2026-31.

Noerr B. Current controversies in the understanding of necrotizing enterocolitis. Part 1. Adv Neonatal Care 2003; 3:107-20.

Guillet R, Stoll BJ, Cotten CM, Gantz M, McDonald S, Pooke WK, et al. Association of H2-blocker therapy and higher incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics 2006;117:e137-42.

Llanos AR, Moss ME, Pinzòn MC, Dye T, Sinkin RA, Kendig JW. Epidemiology of neonatal necrotising enterocolitis: a population-based study. Paediatr Perinat Epidemiol 2002;16:342-9.

Stoll BJ. Epidemiology of necrotizing enterocolitis. Clin Perinatol 1994;21:205-18.

Guthrie SO, Gordon PV, Thomas V, Thorp JA, Peabody J, Clark RH. Necrotizing enterocolitis among neonates in the United States. J Perinatol 2003;23:278-85.

Luig M, Lui K, NSW&ACT NICUS Group. Epidemiology of necrotizing enterocolitis - Part II: Risks and susceptibility of premature infants during the surfactant era: A regional study. J Paediatr Child Health 2005;41:174-9.

Sharma R, Hudak ML, Tepas JJ 3rd, Wludyka PS, Marvin WJ, Bradshaw JA, et al. Impact of gestational age on the clinical presentation and surgical outcome of necrotizing enterocolitis. J Perinatol 2006;26:342-7.

Sharma R, Tepas JJ 3rd, Mollitt DL, Pieper P, Wludyka P. Surgical management of bowel perforations and outcome in very low-birthweight infants (< or = 1,200 g). J Pediatr Surg 2004;39:190-4.

Blakely ML, Tyson JE, Lally KP, McDonald S, Stoll BJ, Stevenson DK, et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age. Pediatrics 2006;117:e680–e687.

Ververidis M, Kiely EM, Spitz L, Drake DP, Eaton S, Pierro A. The clinical significance of thrombocytopenia in neonates with necrotizing enterocolitis. J Pediatr Surg 2001;36:799–803.

Kosloske AM. Indications for operation in necrotizing enterocolitis revisited. J Pediatr Surg 1994;29:663–6.

Puntis J, McNeish AS, Allan RN. Long term prognosis of Crohn’s disease with onset in childhood and adolescence. Gut 1984;25:329–36.

Albanese CT, Rowe MI. Necrotizing enterocolitis. In: O’Neill JA Jr, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG, eds. Pediatric Surgery 5th ed. St. Louis, MO: Mosby; 1998;2: 1297–332.

Dominguez KM, Moss RL. Necrotizing Enterocolitis. In: Holcomb GW III, Murphy JP, Ostlie DJ, eds. Ashcraft’s Pediatric Surgery 6th ed. London,New York:Elsevier-Saunders; 2014;454-67.

Ricketts RR. Surgical treatment of necrotizing enterocolitis and the short bowel syndrome. Clin Perinatol 1994;21:365–87.

Stringer MD, Brereton RJ, Drake DP, Kiely EM, Capps SN, Spitz L. Recurrent necrotizing enterocolitis. J Pediatr Surg 1993;28:979-81.

Ricketts RR, Jerles ML. Neonatal necrotizing enterocolitis: experience with 100 consecutive surgical patients. World J Surg 1990;14:600-5.

Thyoka M, Eaton S, Hall NJ, Drake D, Kiely E, Curry J, et al. Advanced Necrotizing Enterocolitis Part 2: Recurrence of Necrotizing Enterocolitis. Eur J Pediatr Surg 2012;22:13-6.

Lemelle JL, Schmitt M, de Miscault G, Vert P, Hascoet JM. Neonatal necrotizing enterocolitis: a retrospective and multicentric review of 331 cases. Acta Paediatr. Suppl 1994;396:70-3.

Butter A, Flageole H, Laberge JM. The changing face of surgical indications for necrotizing enterocolitis. J Pediatr Surg 2002;37:496-9.

Schimpl G, Höllwarth ME, Fotter R, Becker H. Late intestinal strictures following successful treatment of necrotizing enterocolitis. Acta Paediatr. Suppl1994; 396:80-3.

Downloads

Published

30-12-2019

How to Cite

1.
Kaseng F, Poocharoen W, Niramis R. Surgical Necrotizing Enterocolitis: Outcomes and Factors Affecting Mortality. j dept med ser [Internet]. 2019 Dec. 30 [cited 2022 Aug. 8];44(6):29-38. Available from: https://he02.tci-thaijo.org/index.php/JDMS/article/view/244792

Issue

Section

Original Article