Predictive factors and clinical practice profile for strictures post-necrotising enterocolitis

Area of Science:

• Neonatalogy
• Pediatric Surgery
• Gastroenterology

Background:

• Intestinal stricture is a common and severe complication of necrotizing enterocolitis (NEC) in neonates.
• Post-NEC strictures lead to significant and prolonged morbidity, necessitating better understanding of predictive factors and management outcomes.

Purpose of the Study:

• To identify clinical predictors for the development of intestinal strictures following NEC.
• To evaluate the management outcomes of post-NEC strictures to guide clinical care.

Main Methods:

• Retrospective review of 188 neonates diagnosed with NEC across four academic centers (2011-2016).
• Analysis of clinical data, including demographics, management, laboratory values (PCT, CRP, WBC, plateletcrit), and histopathology.
• Comparison of outcomes between infants with and without post-NEC strictures.

Main Results:

• Late-onset NEC and cesarean delivery were independently associated with a lower risk of stricture development (RR 0.56 and 1.42, respectively).
• Elevated procalcitonin (PCT) at symptom onset was a predictor of stricture (RR 1.82).
• Infants with strictures showed higher CRP, WBC, and plateletcrit levels, longer times to enteral feeds, and prolonged hospitalization.

Conclusions:

• Early-onset NEC and cesarean delivery appear protective against post-NEC intestinal strictures.
• PCT levels at symptom onset may indicate a higher risk for stricture development.
• Post-NEC strictures are associated with delayed enteral feeding and extended hospital stays, highlighting the need for careful medicosurgical management.