Risk factors associated with postnecrotizing enterocolitis strictures in infants

Area of Science:

• Pediatric Surgery
• Neonatology
• Gastroenterology

Background:

• Necrotizing enterocolitis (NEC) survivors frequently experience intestinal strictures, leading to significant long-term complications.
• Post-NEC strictures represent a major cause of morbidity in infants following NEC.

Purpose of the Study:

• To determine the incidence of intestinal strictures following NEC.
• To identify risk factors associated with the development of post-NEC intestinal strictures.

Main Methods:

• Retrospective analysis of 441 patients with NEC Bell's stage ≥2 across three pediatric surgical centers (2005-2013).
• Clinical data were collected to assess the occurrence of clinically relevant post-NEC strictures confirmed radiologically and/or surgically.

Main Results:

• The overall incidence of clinically relevant post-NEC strictures was 19% (37/219) in medically treated and 24% (27/113) in surgically treated NEC patients (p=0.001).
• Elevated C-reactive protein (CRP) levels during the NEC episode were significantly associated with post-NEC stricture development (OR 1.20, p=0.03).
• No strictures were observed in patients with CRP levels below 46 mg/L.

Conclusions:

• This multicenter study confirms a substantial incidence of post-NEC strictures, particularly in surgically managed NEC cases.
• Increased CRP levels during NEC are a significant risk factor for developing intestinal strictures post-NEC.