The Surgical Management of Necrotizing Enterocolitis

Thoracoabdominal and General Surgery

“…Although mortality has been substantial in these neonates, a multifaceted approach to resting and preserving bowel function, nutrition, infectious prophylaxis, and surgical consultation dramatically improved survival [ 204 ]. A general guide for the ability of the gut to support enteral feeds long term is the presence of 30 cm of bowel with the ileocecal valve or 50 cm without [ 237 ]. In extreme cases where the entire intestine is necrotic, withdrawal of care may be an important consideration.…”

“…The indications for surgery include serial examinations that indicate worsening physiological parameters or failure of medical treatment. The precise indications for surgery remain controversial; ideally, surgery is indicated for the presence of gangrenous bowel, before it has perforated [ 237 ]. However, there are no reliable metrics to defi ne such a clinical scenario.…”

“…Necrotizing enterocolitis (NEC) is the most common surgical neonatal emergency affecting up to 0.5 % of all live births and 10 % of low birth weight (<1,500 g) live births [ 237 ]. Advances in neonatal care have improved survival rates for premature and low birth weight infants, as well as those affected by this disease.…”

“…NEC is primarily a clinical diagnosis [ 237 ]. It is classifi ed according to the criteria described by Bell (Table 10.9 ) [ 242 ].…”

Necrotizing enterocolitis: current perspectives

“…Recognized indications for surgery include: pneumoperitoneum due to intestinal perforation; evidence of necrotic bowel; palpable abdominal mass; development of intestinal stricture; and when there is no improvement or deterioration (including persistent hematological and biochemical derangements such as progressive thrombocytopenia and worsening metabolic acidosis) despite maximal conservative therapy. 94,95 Increasing abdominal distension causing difficulty in ventilation may also prompt surgical intervention, including peritoneal drainage (see below). A scoring system comprising metabolic acidosis, hypotension, thrombocytopenia, hyponatremia, positive blood culture, neutropenia, and left shift of neutrophils has been suggested as an adjunct to the clinical and radiological parameters to aid in the timing of surgical intervention, 96 but application of this system is not widely practiced.…”