A prospective evaluation of intestinal stenosis following necrotizing enterocolitis

Schwartz, Marshall Z.; Hayden, C. K.; Richardson, C. Joan; Tyson, Kenneth R.T.; Lobe, Thom E.

doi:10.1016/s0022-3468(82)80443-0

Cited by 58 publications

(21 citation statements)

References 10 publications

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“…[8] After the acute episode of NEC, strictures develop at a variable period irrespective of the mode of management, which is associated with severe and prolonged morbidity (septicemia, perforation, intestinal obstruction) and morbidity secondary to intestinal strictures. [9] The ischemic injury to the inner muscular layer of the intestine plays an important role in the pathogenesis of NEC.…”

Section: Introductionmentioning

confidence: 99%

Predictive factors and clinical practice profile for strictures post-necrotising enterocolitis

Zhang

Chen

Wang³

et al. 2017

Medicine

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Intestinal stricture is a severe and common complication of necrotizing enterocolitis (NEC), causing severe and prolonged morbidity. Our goal was to investigate the clinical predictors for strictures developing after NEC and evaluate the management outcome of the post-NEC strictures to better orient their medicosurgical care.A total of 188 patients diagnosed with NEC with identical treatment protocols throughout the period under study were retrospectively reviewed from 4 academic neonatal centers between from January 1, 2011, and October 31, 2016. Clinical predictive factors and clinical outcomes, including demographic information, clinical management, laboratory data, histopathology of resected bowel segment, and discharge summaries, were evaluated on the basis of with post-NEC strictures or not.Of the involved variables examined, the late-onset NEC [risk ratio (RR), 0.56; 95% confidence interval (95% CI), 0.41–0.92; P < 0.001], cesarean delivery (RR, 1.42; 95% CI, 0.98–2.29; P = 0.026), and first procalcitonin (PCT) (onset of symptoms) (RR, 1.82; 95% CI, 0.98–3.15; P = 0.009) were the independent predictive factors for the post-NEC strictures. C-reactive protein (CRP), white blood cell (WBC), and plateletcrit levels were markedly higher on infants with stricture and elevated levels were maintained until the stricture was healed. Infants with intestinal stricture had significantly longer times to beginning enteral feeds (23.9 ± 12.1), than infants without intestinal stricture (18.6 ± 8.8) (P = 0.023). The median age at discharge was also significantly higher in the group with stricture (P = 0.014).This retrospective and multicenter study demonstrates that the early-onset NEC and cesarean delivery conferred protection over the post-NEC stricture. Infants with post-NEC stricture need prolonged hospitalization.

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Section: Introductionmentioning

confidence: 99%

Predictive factors and clinical practice profile for strictures post-necrotising enterocolitis

Zhang

Chen

Wang³

et al. 2017

Medicine

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“…Intestinal stricture at the time was estimated to affect 20% of NEC survivors [11]–[13] and was associated with severe and prolonged morbidity (septicemia, perforation, intestinal obstruction) [14]–[16]. These data led many authors to recommend systematic contrast study of the digestive tract [11], [17], [18]. Since then, the reported incidence of detectable stricture has increased (to up to 40% of NEC cases), and is higher after initial surgical treatment (20–43%) than after medical treatment (15–30%) [17], [19]–[22].…”

Section: Introductionmentioning

confidence: 99%

Necrotizing Enterocolitis (NEC) and the Risk of Intestinal Stricture: The Value of C-Reactive Protein

et al. 2013

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Necrotizing enterocolitis (NEC) is a severe complication frequently seen during the neonatal period associated with high mortality rate and severe and prolonged morbidity including Post-NEC intestinal stricture. The aim of this study is to define the incidence and risk factors of these post-NEC strictures, in order to better orient their medicosurgical care. Sixty cases of NEC were retrospectively reviewed from a single tertiary center with identical treatment protocols throughout the period under study, including systematic X-ray contrast study. This study reports a high rate of post-NEC intestinal stricture (n = 27/48; 57% of survivors), either in cases treated surgically (91%) and after the medical treatment of NEC (47%). A colonic localization of the strictures was more frequent in medically-treated patients than in those with NEC treated surgically (87% vs. 50%). The length of the strictures was significantly shorter in case of NEC treated medically. No deaths were attributable to the presence of post-NEC stricture. The mean hospitalization time in NICU and the median age at discontinuation of parenteral nutrition were longer in the group with stricture, but this difference was not significant. The median age at discharge was significantly higher in the group with stricture (p = 0.02). The occurrence of post-NEC stricture was significantly associated with the presence of parietal signs of inflammation and thrombopenia (<100 000 platelets/mm3). The mean maximum CRP concentration during acute phase was significantly higher in infants who developed stricture (p<0.001), as was the mean duration of the elevation of CRP levels (p<0.001). The negative predictive value of CRP levels continually <10 mg/dL for the appearance of stricture was 100% in our study. In conclusion, this retrospective and monocentric study demonstrates the correlation between the intensity of the inflammatory syndrome and the risk of secondary intestinal stricture, when systematic contrast study is performed following NEC.

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“…The main reason of post-NEC intestinal obstruction is the intestinal stricture, other reason including adhesion, poor peristalsis, and so on. Stricture is a well-known common complication of NEC during posthealing process, affecting about 20% of NEC survivors [7]. After the acute episode of NEC, Post-NEC intestinal obstruction develop at a variable period irrespective of the mode of management, which is associated with severe and prolonged morbidity (septicemia, perforation, intestinal obstruction) and morbidity secondary to intestinal strictures [8] .The ischemic injury to the inner muscular layer of the intestine plays an important role in the pathogenesis of NEC [9].…”

Section: Advances In Biological Sciencesmentioning

confidence: 99%

The Influence of Surgery Opportunity Choice on the Prognosis of the Post-Necrotizing Enterocolitis Intestinal Obstruction

Zhao¹,

Fu²

2018

Proceedings of the 2018 International Workshop on Bioinformatics, Biochemistry, Biomedical Sciences (BBBS 2018)

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Abstract. Objective: To investigate the treatment effect of the different surgery opportunity choice on the post-necrotizing enterocolitis intestinal obstruction. Methods: A retrospective analysis of our Hospital in recent 8 years, neonatal and pediatric surgery in the diagnosis and treatment of the postnecrotizing enterocolitis intestinal obstruction cases. All the cases were divided into two groups: early operation group and non-early operation group. The cases of non-early operation group were treated conservatively, and would get surgical treatment when the intestinal obstruction occurs repeatedly or the intestinal obstruction recovers difficultly. The survival children were followed up to 6 months. Clinical data were retrospectively analyzed, including the hospital stays, the reoccurrence of intestinal obstruction, weight gain 2 month after discharge. Results: The hospital stays of the experimental group was obviously shorter than that of control group (P<0.05), the reoccurrence rate of intestinal obstruction of the experimental group was obviously lower than that of control group (9.1%vs53.8%) (P<0.05). And the weight gain 2 month after discharge of the experimental group was obviously more than that of control group (P<0.05). Conclusion: Early operation intervention can shorten hospital stay of post-NEC intestinal obstruction, reduce the later complications, and promote the recovery.

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A prospective evaluation of intestinal stenosis following necrotizing enterocolitis

Cited by 58 publications

References 10 publications

Predictive factors and clinical practice profile for strictures post-necrotising enterocolitis

Predictive factors and clinical practice profile for strictures post-necrotising enterocolitis

Necrotizing Enterocolitis (NEC) and the Risk of Intestinal Stricture: The Value of C-Reactive Protein

The Influence of Surgery Opportunity Choice on the Prognosis of the Post-Necrotizing Enterocolitis Intestinal Obstruction

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