Prognostic factors of mortality in newborns with necrotizing enterocolitis submitted to exploratory laparotomy

The aim of this study was to identify and assess mortality predictive factors in newborns with necrotizing enterocolitis (NEC) requiring emergency exploratory laparotomy.

A prospective study of 91 newborns with NEC submitted to exploratory laparotomy was conducted. Clinical outcomes were death and survival 60 days after surgery. Nine variables were analyzed: weight at birth, gestational age, intrauterine growth, sex, gas in the portal vein at abdominal x-ray, pneumoperitoneum, extent of the disease, operative strategies, and extension of bowel resection. Univariate and multivariate analyses were performed to identify mortality predictors.

Mean weight at birth was 1,676 +/- 634.8 g, and mean gestational age was 34 +/- 2.8 weeks. Thirty-nine newborns (42.9%) presented intrauterine growth retardation. Operative techniques included bowel resection with enterostomy (80 patients), bowel resection with primary anastomosis (10 patients), and decompressive enterostomy (1 patient). Six deaths occurred caused by co-existing disease. NEC-related mortality rate was 46.15% (42 of 91).

Two variables, intrauterine growth retardation, and diffuse bowel involvement, were predictive of mortality according to both univariate and multivariate analyses. Site of bowel involvement seems to be important mortality predictors in infants with NEC requiring surgery. The size of our population did not allow statistical analysis of this relationship. Further studies should focus on examining this aspect.