Surgical Interventions for NEC-An Overview

Necrotising enterocolitis is a highly challenging condition in neonatal surgery, with a substantial proportion of affected infants requiring operative intervention with a significant associated morbidity and mortality. Radiological evidence of perforation represents a clear indication for surgery; however, in many other cases, the disease presentation and progression are heterogenous, with significant diagnostic and prognostic uncertainty. The surgical assessment and decision making in these cases relies on integrated judgement of the clinical trajectory, examination, and biochemical and radiological findings, as well as consideration of the comorbidities and gestational age. Although many have been proposed in the literature, there remains to be any universal validated thresholds or criteria for reliably identifying those infants who may be 'failing medical management' and are likely to develop intestinal necrosis. Similarly, comparisons of different surgical approaches (stoma, primary anastomosis, and damage-control strategies) and outcome reporting are often confounded by the disease severity index and patient selection, as well as the generally observational nature of studies within the field. Improved standardisation of disease and severity definitions, and the development of validated prognostic tools, will facilitate the earlier identification of infants most likely to benefit from surgery, which in turn could reduce delays to theatre and improve the outcomes. Multi-centre collaborative datasets provide important evidence in the path to achieving this aim, by providing valuable cohort and outcome data, which also contribute to informed shared decision making with parents and families.