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Fulminanting necrotising enterocolitis: outcome and prognostic factors
M Voss1, S W Moore, I van der Merwe
1Department of Paediatric Surgery, Faculty of Medicine, University of Stellenbosch, Box 19063, Tygerberg 7505, South Africa.
Pediatric Surgery International
|November 3, 1998
Summary
Fulminant necrotising enterocolitis (NEC) in neonates requires prompt surgical intervention. Early surgical management offers a 61% survival rate for resectable NEC, while pan-necrosis indicates a fatal outcome.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Critical care medicine
Background:
- Necrotising enterocolitis (NEC) is a severe gastrointestinal emergency in neonates.
- Fulminant NEC presents a significant challenge in predicting outcomes and guiding treatment.
Purpose of the Study:
- To determine the outcome of infants with fulminant necrotising enterocolitis (NEC).
- To identify predictors of survival in neonates with severe, rapid-onset NEC.
Main Methods:
- Retrospective review of 128 surgically-treated neonates with NEC.
- Correlation of 30-day survival with clinical, laboratory, radiological, and surgical findings.
Main Results:
- Fifty-two neonates had severe, rapid-onset NEC.
- Extent of disease was the sole absolute predictor of survival.
- Pan-necrosis (19 patients) had a uniformly fatal outcome.
- Resectable disease yielded a 30-day survival rate of 61%.
Conclusions:
- Neonates with severe NEC and gangrene responding to resuscitation benefit from active surgical management.
- Percutaneous drainage for non-responsive cases had a uniformly fatal outcome.
- Withdrawing active management for non-responsive cases or pan-necrosis may be reasonable if resources are limited.