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Published on: July 28, 2023
Surgical management of necrotizing enterocolitis and isolated intestinal perforation in premature neonates
Martin L Blakely1, Himesh Gupta, Kevin P Lally
1Division of Pediatric Surgery, University of Tennessee Health Science Center, Memphis, TN, USA. mblakely@utmem.edu
Insights
Necrotizing enterocolitis (NEC) and isolated intestinal perforation (IP) are serious neonatal surgical conditions. While initial mortality rates are similar for drain placement versus laparotomy, long-term neurodevelopmental outcomes require further study.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Critical care medicine
Background:
- Necrotizing enterocolitis (NEC) and isolated intestinal perforation (IP) are common neonatal surgical emergencies.
- These conditions carry a high early mortality rate, approaching 50%.
- Survivors often experience significant growth and neurodevelopmental impairments.
Purpose of the Study:
- To compare the outcomes of initial drain placement versus laparotomy with resection for NEC and IP.
- To investigate potential differences in major morbidity, particularly neurodevelopmental impairment, between surgical approaches.
- To highlight the need for further prospective trials and research into prevention and improved medical treatments.
Main Methods:
- Review of recent prospective studies comparing surgical approaches for NEC and IP.
- Analysis of early mortality rates associated with drain placement versus laparotomy.
- Evaluation of morbidity data, focusing on neurodevelopmental outcomes.
Main Results:
- Early mortality rates appear similar between initial drain placement and laparotomy with resection.
- Potential differences in major morbidity, including neurodevelopmental impairment, between the two surgical strategies warrant further investigation.
Conclusions:
- Current evidence suggests no significant difference in early mortality between drain placement and laparotomy for NEC/IP.
- Further prospective trials are essential to elucidate differences in long-term morbidity, especially neurodevelopmental outcomes.
- Research into prevention and enhanced medical management is crucial for improving infant outcomes.
Abstract:
Necrotizing enterocolitis (NEC) and isolated intestinal perforation (IP) are two relatively common disease conditions that require neonatal surgical therapy. The early mortality rate approaches 50%, and survivors frequently have growth and neurodevelopmental impairment. Much discussion has occurred regarding whether initial drain placement alone or laparotomy with resection of diseased intestine should be the initial surgical therapy. Several recent prospective studies have shown that the early mortality rate is likely not significantly different after either of these surgical approaches. Major morbidity, especially the likelihood for neurodevelopmental impairment, may be different in the two treatment groups. Further prospective trials are needed to further explore this question and are planned. Studies focusing on prevention of NEC and IP and also on improved medical treatment are needed to allow a major advance in the outcomes of infants with NEC and IP. As these studies are being performed, trials evaluating existing medical and surgical therapies are also needed.
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