Necrotizing Enterocolitis (NEC) and the Risk of Intestinal Stricture: The Value of C-Reactive Protein

Abstract

Necrotizing enterocolitis (NEC) is a severe complication frequently seen during the neonatal period associated with high mortality rate and severe and prolonged morbidity including Post-NEC intestinal stricture. The aim of this study is to define the incidence and risk factors of these post-NEC strictures, in order to better orient their medicosurgical care. Sixty cases of NEC were retrospectively reviewed from a single tertiary center with identical treatment protocols throughout the period under study, including systematic X-ray contrast study. This study reports a high rate of post-NEC intestinal stricture (n = 27/48; 57% of survivors), either in cases treated surgically (91%) and after the medical treatment of NEC (47%). A colonic localization of the strictures was more frequent in medically-treated patients than in those with NEC treated surgically (87% vs. 50%). The length of the strictures was significantly shorter in case of NEC treated medically. No deaths were attributable to the presence of post-NEC stricture. The mean hospitalization time in NICU and the median age at discontinuation of parenteral nutrition were longer in the group with stricture, but this difference was not significant. The median age at discharge was significantly higher in the group with stricture (p = 0.02). The occurrence of post-NEC stricture was significantly associated with the presence of parietal signs of inflammation and thrombopenia (<100 000 platelets/mm3). The mean maximum CRP concentration during acute phase was significantly higher in infants who developed stricture (p<0.001), as was the mean duration of the elevation of CRP levels (p<0.001). The negative predictive value of CRP levels continually <10 mg/dL for the appearance of stricture was 100% in our study. In conclusion, this retrospective and monocentric study demonstrates the correlation between the intensity of the inflammatory syndrome and the risk of secondary intestinal stricture, when systematic contrast study is performed following NEC.

Necrotising Enterocolitis - epidemiology and imaging

“…In populations not restricted to a particular range of gestational age or birth weight, mortality rates of 12 to 38,5% have been reported 25,28,84,85,140,201,207,208 with seemingly lower rates in later publication years. After surgical treatment, mortality may be considerably higher.…”

“…After surgical treatment, mortality may be considerably higher. 144,207,209 Reported risk factors for death in NEC include low birth weight, 85,210 early onset and bleeding tendency, 28 hispanic etnicity, and number of ICD-diagnoses. 85 Extension of necrotic bowel, sepsis and organ failure also contribute to adverse outcome.…”

“…85 Extension of necrotic bowel, sepsis and organ failure also contribute to adverse outcome. 33,207 Holman et al found a decreasing NEC mortality rate 1979 through 1986, which they attributed to improved neonatal intensive care, but increasing rates 1986 through 1992, despite improved over-all early survival. 83 Luig and Lui 99 Long term complications include strictures of the bowel in 20--57% of survivors, 24,113 adhesions, enteric fistulas, intestinal insufficiency, and neurodevelopmental impairment, as well as secondary complications due to parenteral nutrition and prolonged intensive care.…”

“…83 Luig and Lui 99 Long term complications include strictures of the bowel in 20--57% of survivors, 24,113 adhesions, enteric fistulas, intestinal insufficiency, and neurodevelopmental impairment, as well as secondary complications due to parenteral nutrition and prolonged intensive care. 2,10,207,211 Data from Canada and Sweden show that 73-83% of survivors after extremely preterm birth have no severe neurodevelopmental impairment. 212,213 NEC, however, significantly increases the risk.…”

The Application of combination of External Drainage from Intestinal Cavity and Peritoneal Drainage on the Surgical Treatment for Neonates with Necrotizing Enterocolitis

“…[5] Emergency surgical intervention is considered in condition with deteriorating clinical condition and intestinal perforation. [6,7] The operation method for the NEC cases is to according to the degree and scope of bowel necrosis. In most situations, we resect the necrotic bowel and perform the jejunostomy, and 3 months later, ostomy closure will be performed.…”