Impact of gestational age on the clinical presentation and surgical outcome of necrotizing enterocolitis

Abstract

Objective: This investigation tests the hypothesis that the clinical presentation and the outcome of necrotizing enterocolitis (NEC) vary with gestational age (GA).Methods: All infants admitted to our center between October 1991 and September 2003 were evaluated weekly to identify confirmed cases of NEC. Based upon GA, these infants were divided into five groups: Extremely premature (EP, 23 to 26 weeks), very premature (VP, 27 to 29 weeks), moderately premature (MP, 30 to 34 weeks), near-term (NT, 35 to 36 weeks), and term (T, 37 to 42 weeks).Results: A total of 202 infants developed NEC. The most common sign of NEC among EP infants was ileus (77%), followed by abdominal distention (71%), emesis (58%), pneumoperitoneum (54%), fixed intestinal loop (52%), gasless abdomen (42%) and bloody stools (17%). Intramural gas was detected in 100% of T but was present in only 29% of EP infants (P<0.0001). Similarly, portal venous gas was common in T but infrequent in the EP infants (47 vs 10%, P<0.0001). Despite a higher peritoneal drain insertion rate (31 vs 5%, P<0.001) and a higher mortality rate (33 vs 10%, P ¼ 0.05) in EP compared to T infants, other clinical outcomes were not different. Conclusions:The clinical presentation of NEC is different in EP compared to more mature infants; however, outcome among NEC survivors is similar across all GA. Reliance solely on observation of intramural or on portal venous gas in EP infants may lead to a delay or failure in the diagnosis.

Prenatal or postnatal indomethacin exposure and neonatal gut injury associated with isolated intestinal perforation and necrotizing enterocolitis

“…We have shown that abdominal distention, ileus and pneumoperitoneum are more common manifestations of NEC in extremely premature infants than are pneumatosis or portal venous gas. 29 Nonetheless, similar to our findings, Attridge et al 13 did report an association between early indomethacin exposure and intestinal perforation. Unlike our study subjects, their population included infants who received dexamethasone at 0-3 days of life.…”

Incidence and enteral feed antecedents of severe neonatal necrotising enterocolitis across neonatal networks in England, 2012–13: a whole-population surveillance study

“…23 Wide global variation is reported in the rate of NEC of all grades of severity, but our rates for laparotomy and mortality are similar to published data from Canada, 32,33 Australia 6 , and the United States. The finding that infants of lower GA develop NEC at a later postnatal age is also in accord with other studies [33][34][35] including the Probiotic in Preterms trial (PiPs) conducted in the south-east of England.…”

Necrotizing enterocolitis: current perspectives

“…14,34 Evidence is emerging that the age of onset of NEC is inversely proportional to the gestational age at birth, ie, the more immature the infant, the later the onset of NEC. 34,35 The barrier function of the preterm gastrointestinal tract is immature, both in its structure and secretory activity. [36][37][38][39][40] Mucosal permeability of the preterm gut is higher compared …”