Neonatal necrotizing enterocolits

Henry, Marion C.W.; Moss, Richard L.

doi:10.1053/j.sempedsurg.2008.02.005

Cited by 113 publications

(72 citation statements)

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“…Diagnostic procedures such as blood tests and abdominal radiography will be performed regularly [3,11]. Although approximately half of all NEC infants recover with conservative treatment, others will develop progressive disease requiring surgery [12,13,14]. The need for surgery in these critically ill neonates is associated with a high postoperative mortality [8,12,15].…”

Section: Introductionmentioning

confidence: 99%

Clinical Importance of a Fixed Bowel Loop in the Treatment of Necrotizing Enterocolitis

Muller¹,

Schurink²,

Bos

et al. 2013

Neonatology

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Background: The need for surgical treatment in neonates with necrotizing enterocolitis (NEC) is associated with high mortality. Although pneumoperitoneum and progressive disease are generally accepted indications for surgery, it is unclear whether a fixed bowel loop (FBL) should prompt surgery. Objective: To determine the relationship between an FBL, type of treatment, and death in the management of NEC. Methods: Retrospective analysis (January 2000-December 2011) of all neonates with definite NEC in a tertiary neonatal intensive care unit. FBL was defined as a persistent (i.e. >24 h) dilated intestinal segment present on serial abdominal X-rays. Results: NEC was diagnosed in 141 neonates (median gestational age 30 weeks; median birth weight 1,340 g). An FBL was reported in 38 (27%) patients, of whom 18 were treated surgically. Mortality among FBL patients was independent of the type of treatment (surgical versus conservative): 8/18 and 7/20, respectively (p = 0.55). Of the 103 patients without FBL, 37 (36%) were treated surgically, which is comparable to the FBL group. Again, mortality was not related to the type of treatment (surgical versus conservative): 5/37 and 6/66, respectively (p = 0.49). The presence of an FBL was associated with mortality: more patients with an FBL (15/38, 39%) died than without an FBL (11/103, 11%; odds ratio 5.45, 95% confidence interval 2.21-13.45; p < 0.01). Conclusions: In NEC patients, an FBL is associated with increased mortality. On its own it has moderate significance to guide treatment. Nevertheless, because it reflects disease severity, early recognition is important and prompt (surgical) treatment should be considered.

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Section: Introductionmentioning

confidence: 99%

Clinical Importance of a Fixed Bowel Loop in the Treatment of Necrotizing Enterocolitis

Muller¹,

Schurink²,

Bos

et al. 2013

Neonatology

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“…Peritoneal drainage for unstable infants, introduced by Ein et al in 1977, and primary anastomoses were avoided in our series [12]. In a meta-analysis, Henry and Moss (2008) were unable to identify differences in the survival between infants treated with a laparotomy and those treated with primary peritoneal drainage for NEC [8]. However, peritoneal drainage requires a significant number of secondary surgical procedures.…”

Section: Discussionmentioning

confidence: 88%

“…In addition, Gavilanes and coworkers showed that the implantation of cerebrospinal fluid reservoirs can be performed in NICUs [7]. Mortality rates from NEC are generally high, ranging from 15% to 30% [8]. However, necrotizing enterocolitis is an umbrella diagnosis for the different defined entities that are called acquired intestinal disease.…”

Section: Discussionmentioning

confidence: 99%

Emergency Surgical Intervention by Mobile Surgical Team in the NICU

Tröbs¹,

Stein²,

Felderhoff³

et al. 2014

OJPed

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The objective of this study was to describe our NICU's (neonatal intensive care unit) experience with mobile surgical team and to demonstrate its effectiveness. Method: We analyzed the data of 17 consecutive very low birth weight and extremely low birth weight infants over 3 years who underwent 22 procedures (19 emergency and 3 elective). The gestational age at birth was a median of 25 weeks (range 24 -39), and the median birth weight was 613 g (range from 340 g to 1100 g). The infants received their operations during their first 2 weeks of life (median 7 days, range from 1 to 14). Results: The spectrum of primary surgical diagnoses included spontaneous intestinal perforations (n = 8), gastric perforations (n = 3), necrotizing enterocolitis (n = 2), meconium ileus (n = 2), and miscellaneous (n = 2). An emergency laparotomy with either a bowel or a gastric procedure was performed in 16 cases. Postoperatively, all infants required mechanical ventilation from 1 to 43 days (median 6.5 days). Complications included a metachronous small bowel perforation, an ileostomy retraction, a prolapsed stoma, and impaired wound healing; we had one postoperative death. Two infants died later in the NICU (mortality 3 of 16; 19%). Conclusion: Off-site surgery for preterm infants in the NICU is feasible. This approach prevents the risks of transportation, and parents and neonatologists alike feel comfortable with this regimen. However, biases may exist regarding the surgeon's decision to operate, the choice of procedure, and the follow-up.

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“…It is considered the most frequent surgical emergency during the neonatal period [2] and 27-50% of these patients will need surgical treatment. Despite all medical advances in the management and treatment of these infants, the mortality rates remain as high as 12-30% [1].…”

Section: Introductionmentioning

confidence: 99%

“…Necrotizing enterocolitis (NEC) affects the 3-7% of preterm and low weight birth infants [1]. It is considered the most frequent surgical emergency during the neonatal period [2] and 27-50% of these patients will need surgical treatment.…”

Section: Introductionmentioning

confidence: 99%