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Colonic strictures following successful medical management of necrotizing enterocolitis: a prospective study
J Radhakrishnan1, G Blechman, C Shrader
1Department of Pediatrics, Lutheran General Children's Medical Center, Park Ridge, IL.
Insights
This study evaluated 50 infants with necrotizing enterocolitis (NEC). Contrast studies safely identified strictures in 18% of patients, enabling successful feeding after intervention.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Diagnostic imaging
Background:
- Neonatal necrotizing enterocolitis (NEC) is a serious condition requiring prompt management.
- Post-NEC intestinal strictures can complicate recovery and feeding.
- Early identification of strictures is crucial for successful infant feeding outcomes.
Purpose of the Study:
- To assess the safety and reliability of upper gastrointestinal (GI) contrast studies for diagnosing strictures in infants recovering from NEC.
- To determine the incidence of post-NEC strictures requiring intervention.
- To evaluate the efficacy of contrast studies in guiding feeding protocols.
Main Methods:
- Prospective study of 50 infants with medically treated NEC.
- Upper GI contrast studies performed 14 days post-healing, before feeding initiation.
- Follow-up contrast enema used for questionable findings.
- Surgical intervention for confirmed strictures.
Main Results:
- 18% (9/50) of infants demonstrated strictures on contrast studies.
- 72% (36/50) had normal GI exams and responded well to increased feeding.
- 10% (5/50) with questionable exams had normal follow-up enemas and were successfully fed.
- All infants with strictures underwent successful resection and feeding restoration.
- No delayed strictures were observed.
Conclusions:
- Upper GI contrast studies are a safe, efficient, and reliable method for diagnosing NEC-related strictures.
- This diagnostic approach facilitates timely intervention and successful feeding establishment in infants recovering from NEC.
- Contrast studies aid in differentiating infants requiring intervention from those who can proceed with feeding protocols.
Abstract:
This is a prospective study of 50 patients with neonatal necrotizing enterocolitis (NEC) treated successfully by medical means. They were all screened with an upper gastrointestinal (GI) contrast study after 14 days of healing and prior to establishment of feeding. Thirty-six patients (72%) with normal upper GI examinations responded well to a graduated increase in feeding. Another 5 (10%) with questionable areas on their upper GI examination had a normal follow-up contrast enema. Feeding was successfully established in this group of infants also. The remaining 9 patients (18%) had demonstrable strictures in both contrast studies. After elective resection of strictures with restoration of intestinal continuity, they were also fed successfully. No delayed strictures were seen in any of the patients. We propose that this method of evaluation is safe, efficient and reliable in the diagnosis of strictures that develop in patients recovering from NEC.