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Long-term follow-up after surgical management of necrotizing enterocolitis: sixty-three cases
Insights
Necrotizing enterocolitis surgery in infants can lead to significant long-term issues, including short bowel syndrome and developmental delays. Late mortality remains a concern, particularly for premature infants with low birth weight.
Area of Science:
- Neonatal Surgery
- Pediatric Gastroenterology
- Neonatal Intensive Care
Background:
- Necrotizing enterocolitis (NEC) is a severe gastrointestinal emergency in neonates.
- Surgical intervention for NEC presents significant challenges and potential for long-term complications.
Purpose of the Study:
- To evaluate the long-term complications and mortality in infants who underwent surgical intervention for NEC.
- To identify risk factors associated with mortality and morbidity in this cohort.
Main Methods:
- Retrospective review of 125 infants undergoing NEC surgery between 1972-1984.
- Analysis of long-term outcomes in 63 survivors >30 days postoperatively.
- Assessment of associated medical problems, surgical procedures, and late mortality.
Main Results:
- 23% late mortality rate, associated with prematurity (gestational age <31 weeks, birth weight <1000g), sepsis, respiratory failure, and cardiac anomalies.
- Common complications included short bowel syndrome (24 infants), cholestasis (17), seizures (8), and nutritional rickets (6).
- Significant developmental and intellectual delays were observed in survivors.
Conclusions:
- Surgical NEC management is associated with substantial long-term morbidity and mortality.
- Prematurity and low birth weight are critical risk factors for poor outcomes.
- Multidisciplinary follow-up is essential for managing developmental and medical complications in NEC survivors.
Abstract:
One hundred twenty-five infants underwent surgical intervention for necrotizing enterocolitis between 1972 and 1984. Sixty-three infants, who survived more than 30 days postoperatively, were evaluated for long-term complications. There were 28 girls and 35 boys (mean birth weight 1,725 +/- 890 g; gestational age 32 +/- 4 weeks). Associated problems included hyaline membrane disease (43), cardiac anomalies (25), and trisomy 21(2). Thirty-six survivors required long-term ventilatory support. Fifty-nine infants underwent bowel resection and enterostomy, 3 decompressing enterostomies without resection, and 1, exploratory laparotomy only. Enterostomies were closed at four months. Twenty four had short bowel syndrome. Fifteen infants subsequently died for a late mortality rate of 23%. Mortality was related to sepsis (3), respiratory failure (5), cardiac anomalies (3), cardio-respiratory arrest (2), and TPN related liver failure (2), and was common with gestational age less than 31 weeks and birth weight less than 1,000 g. Medical problems included cholestasis (17), TPN induced cirrhosis (3), meningitis (3), seizures (8), and nutritional rickets (6). Significant developmental and intellectual delays were observed.