Refining the Surgical Necrotizing Enterocolitis Protocol: Impact of Clinical Factors on Laparotomy Risk

Area of Science:

• Neonatal surgery
• Pediatric surgery
• Gastroenterology

Background:

• No universally accepted surgical management for spontaneous intestinal perforation (SIP) and surgical necrotizing enterocolitis (NEC) in low birth weight infants.
• Institutional protocol stratifies infants with surgical NEC or SIP to peritoneal drain (PD) or laparotomy (LAP).

Purpose of the Study:

• Identify factors associated with conversion from PD to LAP in infants with surgical NEC or SIP.
• Analyze demographic, clinical, and treatment variables predicting progression to LAP.

Main Methods:

• Retrospective review of infants undergoing PD between June 2014 and October 2024.
• Analysis of variables including birth weight, postnatal age, pneumatosis, portal venous gas, blood transfusion, and NeoProfen exposure.
• Comparison of infants who progressed to LAP versus those managed with PD alone.

Main Results:

• Blood transfusion within 7 days of intervention was more common in infants progressing to LAP (96.4%) compared to those managed without LAP (57.1%) (P = 0.003).
• Preoperative NeoProfen exposure was less frequent in infants requiring LAP (10.7%) than those not progressing to LAP (42.9%) (P = 0.017).
• Protocol nonadherence occurred in 38% of cases.

Conclusions:

• Blood transfusion within 7 days of diagnosis is associated with progression from PD to LAP in surgical NEC or SIP.
• NeoProfen administration is negatively associated with progression to LAP.
• These modifiable factors may help refine protocol-based management for surgical NEC and SIP.