The role of second-look laparotomy in necrotizing enterocolitis

The mortality in newborns with necrotizing entercolitis (NEC) remains unacceptably high. To attempt to improve survival, the most critically ill 14 (of 32 total) newborns with NEC and perforation underwent planned second-look laparotomy 24 to 36 hours after initial exploration to reassess questionably viable bowel and resect if necessary, irrigate purulent material, and search for further perforation. Survival was 10/14 (71%) with, and 12/18 (66%) without second-look laparotomy. Culture-positive pus was found in 14 cases, while in 6 necrotic bowel, and in 2 others a perforation was found at second look. These data suggest that aggressive second-look laparotomy can improve survival in the critically ill neonate with NEC and perforation.