Surgical management of necrotising enterocolitis in Sweden: A national cohort study.
necrotising enterocolitis
portal venous gas
preterm
surgical neonates
Journal
Acta paediatrica (Oslo, Norway : 1992)
ISSN: 1651-2227
Titre abrégé: Acta Paediatr
Pays: Norway
ID NLM: 9205968
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
revised:
06
05
2023
received:
20
03
2023
accepted:
09
05
2023
medline:
11
7
2023
pubmed:
11
5
2023
entrez:
11
5
2023
Statut:
ppublish
Résumé
Necrotising enterocolitis (NEC) is the dominating surgical emergency in preterm neonates. The aims were to investigate indications, surgical management and mortality for surgically treated neonates with NEC. Data were retrieved from the Swedish Neonatal Quality Register for Swedish neonates with surgically treated NEC from 1 January 2017 to 31 December 2021. Diagnosis was validated by surgical records and histopathology. Neonates with isolated spontaneous intestinal perforation were excluded. In total, 109 neonates were included. Median gestational age was 25 weeks (22-38), and median birth weight was 771 g (269-3920). Preoperative pneumoperitoneum was found in 32%, portal venous gas in 25% and clinical deterioration on conservative treatment in 26% of the neonates. Among the 97 neonates presenting with small bowel necrosis, single-focal NEC occurred in 38 (39%), multifocal NEC in 35 (36%) and panintestinal NEC in 24 (25%). A primary anastomosis was performed in 10/87 (11%) of the neonates with bowel resection at primary surgery. Clip-and-drop technique was applied in 24/87 (28%).Mortality rate was 37%. Mortality was well comparable with earlier reports considering exclusion of spontaneous intestinal perforation (SIP) and the low gestational age of the study population. Resection of necrotic bowel with stoma formation was the dominating surgical method.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1683-1688Subventions
Organisme : HRH Crown Princess Lovisa's Foundation
Informations de copyright
© 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.
Références
Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011;364(3):255-264.
Samuels N, van de Graaf RA, de Jonge RCJ, Reiss IKM, Vermeulen MJ. Risk factors for necrotizing enterocolitis in neonates: a systematic review of prognostic studies. BMC Pediatr. 2017;17(1):105.
Fitzgibbons SC, Ching Y, Yu D, et al. Mortality of necrotizing enterocolitis expressed by birth weight categories. J Pediatr Surg. 2009;44(6):1072-1075.
Thyoka M, de Coppi P, Eaton S, et al. Advanced necrotizing enterocolitis part 1: mortality. Eur J Pediatr Surg. 2012;22(1):8-12.
Kastenberg ZJ, Sylvester KG. The surgical management of necrotizing enterocolitis. Clin Perinatol. 2013;40:135-148.
Elfvin A, Dinsdale E, Wales PW, Moore AM. Low birthweight, gestational age, need for surgical intervention and gram-negative bacteraemia predict intestinal failure following necrotising enterocolitis. Acta Paediatr. 2015;104:771-776.
Hansen ML, Juhl SM, Fonnest G, Greisen G. Surgical findings during exploratory laparotomy are closely related to mortality in premature infants with necrotizing enterocolitis. Acta Paediatr. 2017;106(3):399-404.
Gfroerer S, Fiegel H, Schloesser RL, Rolle U. Primary laparotomy is effective and safe in the treatment of necrotizing enterocolitis. World J Surg. 2014;38(10):2730-2734.
Jones IH, Hall NJ. Contemporary outcomes for infants with necrotizing enterocolitis-a systematic review. J Pediatr. 2020;220:86-92.e3.
Pang KK, Chao NS, Wong BP, Leung MW, Liu KK. The clip and drop back technique in the management of multifocal necrotizing enterocolitis: a single centre experience. Eur J Pediatr Surg. 2012;22:85-90.
Knell J, Han SM, Jaksic T, Modi BP. Current status of necrotizing enterocolitis. Curr Probl Surg. 2019;56(1):11-38.
Pierro A. The surgical management of necrotising enterocolitis. Early Hum Dev. 2005;81(1):79-85.
Norman M, Källén K, Wahlström E, Håkansson S, SNQ Collaboration. The Swedish neonatal quality register - contents, completeness and validity. Acta Paediatr. 2019;108(8):1411-1418.
Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187:1-7.
Gordon P, Christensen R, Weitkamp JH, Maheshwari A. Mapping the new world of necrotizing enterocolitis (NEC): review and opinion. EJ Neonatol Res. 2012;2(4):145-172.
Molik KA, West KW, Rescorla FJ, Scherer LR, Engum SA, Grosfeld JL. Portal venous air: the poor prognosis persists. J Pediatr Surg. 2001;36:1143-1145.
Hull MA, Fisher JG, Gutierrez IM, et al. Mortality and management of surgical necrotizing enterocolitis in very low birth weight neonates: a prospective cohort study. J Am Coll Surg. 2014;218:1148-1155.
Allin BSR, Long AM, Gupta A, Lakhoo K, Knight M, British Association of Paediatric Surgeons Congenital Anomalies Surveillance System Necrotising Enterocolitis Collaboration. One-year outcomes following surgery for necrotising enterocolitis: a UK-wide cohort study. Arch Dis Child Fetal Neonatal Ed. 2018;103(5):F461-F466.
Alexander F, Smith A. Mortality in micro-premature infants with necrotizing enterocolitis treated by primary laparotomy is independent of gestational age and birth weight. Pediatr Surg Int. 2008;24:415-419.
Fredriksson F, Nyström N, Waldenvik K, et al. Improved outcome of intestinal failure in preterm infants. J Pediatr Gastroenterol Nutr. 2020;71(2):223-231.
Alexander KM, Chan SS, Opfer E, et al. Implementation of bowel ultrasound practice for the diagnosis and management of necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed. 2021;106(1):96-103.
Palleri E, Aghamn I, Bexelius TS, Bartocci M, Wester T. The effect of gestational age on clinical and radiological presentation of necrotizing enterocolitis. J Pediatr Surg. 2018;53(9):1660-1664.
Tam AL, Camberos A, Applebaum H. Surgical decision making in necrotizing enterocolitis and focal intestinal perforation: predictive value of radiologic findings. J Pediatr Surg. 2002;37:1688-1691.
Fredriksson F, Engstrand LH. Survival rates for surgically treated necrotising enterocolitis have improved over the last four decades. Acta Paediatr. 2019;108(9):1603-1608.
Haricharan RN, Gallimore JP, Nasr A. Primary anastomosis or ostomy in necrotizing enterocolitis? Pediatr Surg Int. 2017;33:1139-1145.
Thakkar HS, Lakhoo K. The surgical management of necrotising enterocolitis (NEC). Early Hum Dev. 2016;97:25-28.
Vaughan WG, Grosfeld JL, West K, Scherer LR 3rd, Villamizar E, Rescorla FJ. Avoidance of stomas and delayed anastomosis for bowel necrosis: the “clip and drop-back” technique. Pediatr Surg. 1996;31(4):542-545.
Garg PM, Bernieh A, Hitt MM, et al. Incomplete resection of necrotic bowel may increase mortality in infants with necrotizing enterocolitis. Pediatr Res. 2021;89(1):163-170.
Ron O, Davenport M, Patel S, et al. Outcomes of the “clip and drop” technique for multifocal necrotizing enterocolitis. J Pediatr Surg. 2009;44:749-754.