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Updated: Aug 8, 2026
A Novel Human Epithelial Enteroid Model of Necrotizing Enterocolitis
Published on: April 10, 2019
Necrotizing Enterocolitis in a Dutch Cohort of Very Preterm Infants: Prevalence, Mortality, and Long-Term Outcomes
Ceren Imren1, Lotte E Vlug2, Barbara A E de Koning2
1Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
Insights
Necrotizing enterocolitis (NEC) in preterm infants has high mortality, particularly with surgery. However, survivors show rare long-term intestinal failure and neurodevelopmental delays at 2 years corrected age.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Gastroenterology
Background:
- Necrotizing enterocolitis (NEC) is a severe gastrointestinal condition in preterm infants.
- Understanding NEC's long-term outcomes is crucial for parental counseling and care strategies.
Purpose of the Study:
- To investigate the disease course and outcomes of NEC up to 2 years corrected age (CA).
- To analyze outcomes separately for medically and surgically treated NEC infants.
Main Methods:
- Retrospective cohort study of preterm infants (birth weight < 1,500g, GA < 32 weeks) diagnosed with NEC (Bell's stage ≥ II) between 2008-2020.
- Data collected on prevalence, mortality, surgery, intestinal failure (IF), growth, and neurodevelopment at 2-year follow-up.
Main Results:
- 200 out of 3,456 preterm infants had NEC; 135 required surgery.
- Mortality was 88% for medical NEC vs. 40% for surgical NEC at 60 days.
- Surgical complications occurred in 23/77 patients; 25/77 developed IF. At 2-year follow-up, 3% had severe weight delay, 6% motor delay, and 2% cognitive delay.
Conclusions:
- Mortality in NEC is high, especially for surgically treated infants.
- Surgical complication rates are comparable to prior studies.
- Persisting intestinal failure and severe neurodevelopmental delays were rare in NEC survivors at 2 years CA.
Introduction:
To improve counseling of parents and to guide care strategies, we studied the disease course and outcomes of necrotizing enterocolitis (NEC) up to 2 years of corrected age (CA) from a multidisciplinary perspective.
Materials And Methods:
This was a retrospective cohort study in preterm infants (birth weight < 1,500 g, gestational age < 32 weeks), diagnosed with NEC (Bell's stage ≥ II) from 2008 through 2020. Data on prevalence, mortality, surgery, intestinal failure (IF), growth, and neurodevelopment at 2-year follow-up were separately analyzed for medically and surgically treated children.
Results:
Of 3,456 preterm infants, 200 (6%) were diagnosed with NEC, of whom 135 developed an indication for surgery within 7 days after the diagnosis; 28/135 died before surgery, and 37/107 died after an open-and-close procedure. An enterostomy was constructed in 62 patients and an end-to-end anastomosis in 15. The postoperative course was described for 77 patients, of whom 23 developed surgical complications (12/23 incisional hernias, 9/23 anastomotic strictures), 13/77 a short bowel, and 25/77 IF. Sixty-day survival after birth for medical NEC patients was 88% (hazard ratio [HR]: 0.698; p = 0.318), and for surgically treated NEC patients was 40% (HR: 3.729; p < 0.001). At 2-year follow-up, one patient received parenteral nutrition. Severe delay in weight for age, motor, and cognitive development was seen in 3, 6, and 2%, respectively.
Conclusion:
In this cohort, the mortality rate was high, especially in surgically treated NEC patients. The surgical complication rate is comparable to previous studies, but in surviving patients, persisting IF and severe delay in growth and neurodevelopment at 2 years CA were relatively rare.
