Necrotizing enterocolitis: incidence, operative care, and outcome

Area of Science:

• Pediatric Surgery
• Neonatal Medicine
• Gastroenterology

Background:

• Necrotizing enterocolitis (NEC) is a serious intestinal disease affecting newborns, particularly premature infants.
• Jefferson Davis Hospital observed NEC incidence rates of 3 per 1,000 live births and 30 per 1,000 low birth weight births.
• The study period saw improved survival for small infants, leading to a smaller NEC patient population over time.

Purpose of the Study:

• To analyze the incidence, clinical characteristics, and surgical management of necrotizing enterocolitis (NEC).
• To evaluate the outcomes and survival rates of infants with NEC, including those requiring surgical intervention.
• To assess the safety and efficacy of primary anastomosis in surgical NEC cases.

Main Methods:

• Retrospective analysis of infants diagnosed with NEC at Jefferson Davis Hospital between 1982 and 1984.
• Categorization of NEC cases based on acute presentation versus late sequelae requiring surgery.
• Evaluation of surgical interventions, including primary anastomosis and enterostomy closure, and their associated outcomes.

Main Results:

• NEC most frequently affected infants weighing 750-1,500g; smaller infants with NEC had a higher likelihood of requiring surgery.
• 31% of infants with acute NEC required surgical intervention, with an additional 11% needing surgery for late sequelae.
• Overall survival for infants with NEC was 75%. Survival for surgically treated infants was 68% (63% for acute NEC, 87% for late sequelae).

Conclusions:

• Primary anastomosis in selected NEC patients did not increase mortality and simplified postoperative care.
• Experienced pediatric surgeons could predict suitability for primary resection and anastomosis at surgery.
• The rate of primary anastomosis increased to approximately 50% with surgeon experience.