A UK wide cohort study describing management and outcomes for infants with surgical Necrotising Enterocolitis

Abstract

The Royal College of Surgeons have proposed using outcomes from necrotising enterocolitis (NEC) surgery for revalidation of neonatal surgeons. The aim of this study was therefore to calculate the number of infants in the UK/Ireland with surgical NEC and describe outcomes that could be used for national benchmarking and counselling of parents. A prospective nationwide cohort study of every infant requiring surgical intervention for NEC in the UK was conducted between 01/03/13 and 28/02/14. Primary outcome was mortality at 28-days. Secondary outcomes included discharge, post-operative complication, and TPN requirement. 236 infants were included, 43(18%) of whom died, and eight(3%) of whom were discharged prior to 28-days post decision to intervene surgically. Sixty infants who underwent laparotomy (27%) experienced a complication, and 67(35%) of those who were alive at 28 days were parenteral nutrition free. Following multi-variable modelling, presence of a non-cardiac congenital anomaly (aOR 5.17, 95% CI 1.9–14.1), abdominal wall erythema or discolouration at presentation (aOR 2.51, 95% CI 1.23–5.1), diagnosis of single intestinal perforation at laparotomy (aOR 3.1 95% CI 1.05–9.3), and necessity to perform a clip and drop procedure (aOR 30, 95% CI 3.9–237) were associated with increased 28-day mortality. These results can be used for national benchmarking and counselling of parents.

Thirty day mortality after neonatal laparotomy in a Chinese tertiary hospital

“…The present results are largely consistent with others that reported high postoperative morbidity and mortality following surgery for NEC, given its progression to sepsis with multi‐organ failure . A UK cohort study describing outcomes for 236 infants with surgical NEC identified a mortality rate of 18% . CDH is well recognized as a challenging surgical condition with high mortality, and fortunately the incidence is relatively low.…”

Current Research on the Epidemiology, Pathogenesis, and Management of Necrotizing Enterocolitis

“…Routinely acquired examination and radiological data from this study have also been used to generate a gestational age-specific case definition, with a sensitivity of 66% and a specificity of 94%, which the authors suggest should be widely adopted [11]. The surgical study, from the British Association of Paediatric Surgeons Congenital Anomalies Surveillance System, collected data from 28 neonatal surgical centres over 1 year and showed that 236 infants required surgery for NEC in the UK in this time period, and highlighted the variation in surgical practices [97]. In both epidemiological studies, infants were identified who died without having surgery.…”

Abdominal ultrasound should become part of standard care for early diagnosis and management of necrotising enterocolitis: a narrative review

“…The prognosis for patients with NEC worsens after bowel perforation 57. The only universally accepted indication for a surgical procedure in NEC is the presence of perforation, which may manifest as free air and/or complex fluid in the peritoneal cavity.…”