Related Experiment Videos
Changing trends in necrotizing enterocolitis. Experience with 302 cases in two decades.
J L Grosfeld1, H Cheu, M Schlatter
1Department of Surgery, Indiana University Medical Center, Indianapolis 46202-5200.
Annals of Surgery
|September 1, 1991
Summary
Necrotizing enterocolitis (NEC) treatment improved significantly between 1972-1990. Despite sicker, smaller infants, overall survival increased from 58% to 82%, with better outcomes for premature infants and those with portal vein air.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Gastroenterology
Background:
- Necrotizing enterocolitis (NEC) is a serious gastrointestinal condition affecting premature infants.
- Treatment strategies and outcomes for NEC have evolved over time.
- Comparing early and later treatment eras can reveal advancements in care.
Purpose of the Study:
- To compare the treatment and outcomes of necrotizing enterocolitis (NEC) in infants between two distinct periods: 1972-1982 and 1983-1990.
- To evaluate the impact of changes in diagnostic criteria and surgical indications on NEC survival rates.
- To assess survival improvements in specific subgroups of infants, including those with portal vein air.
Main Methods:
- Retrospective analysis of 302 infants diagnosed with NEC between 1972 and 1990.
- Categorization of infants into two treatment periods: 1972-1982 (n=176) and 1983-1990 (n=126).
- Comparison of patient demographics, clinical characteristics, treatment approaches (medical vs. surgical), and survival rates between the two eras.
Main Results:
- Infants in the later era (1983-1990) were more premature, had lower birth weights, and presented later with symptoms, but had fewer complications like acidosis and oliguria.
- The use of portal vein air (PVA) on radiographs as an indicator for surgery was introduced in 1983, correlating with improved survival (29% to 64%).
- Overall survival improved from 58% (1972-1982) to 82% (1983-1990) (p<0.001), with operative survival increasing from 51% to 75% (p<0.002).
- Improved survival was noted in infants between 24-27 weeks gestation and those weighing <1000g in the later period.
Conclusions:
- Despite treating smaller and more immature infants, significant improvements in NEC survival rates were achieved between 1972-1990.
- Changes in management, including the use of PVA as a surgical indicator, contributed to better outcomes.
- Long-term survival rates also showed improvement in the more recent treatment era.