Does the initial surgery for necrotizing enterocolitis matter? Comparative outcomes for laparotomy vs. peritoneal drain as initial surgery for necrotizing enterocolitis in infants &lt; 1000 g birth weight

Yanowitz, Toby; Sullivan, Kevin M.; Piazza, Anthony J.; Brozanski, Beverly; Zaniletti, Isabella; Sharma, Jotishna; DiGeronimo, Robert; Nayak, Sujir Pritha; Wadhawan, Rajan; Reber, Kristina M.; Murthy, Karna

doi:10.1016/j.jpedsurg.2018.12.010

Cited by 12 publications

(5 citation statements)

References 23 publications

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“…The association remained significant even after adjusting for identified confounders. However, like our study, there was no significant difference between the two intervention groups regarding mortality as a single or composite outcome with short bowel syndrome [18]. Likewise, in the two RCTs by Moss et al and Rees et al, there was no significant difference in survival between the drain and primary laparotomy groups [15,16].…”

Section: Discussionsupporting

confidence: 56%

“…There was no difference between groups in terms of total TPN duration and time to reach the full feed in the present study. In a large retrospective cohort study involving 528 infants with <32 weeks’ gestation and <1000 grams with surgical NEC, primary laparotomy was the initial procedure in 68% of infants; infants receiving LAP were older and heavier and had fewer incidence of severe intraventricular hemorrhage [ 18 ]. In the same study, survivors who had undergone laparotomy as the initial surgical approach were more likely to develop short bowel syndrome.…”

Section: Discussionmentioning

confidence: 99%

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Primary Peritoneal Drainage Versus Laparotomy for Perforated Necrotizing Enterocolitis in Very-Low-Birth-Weight Infants: A Retrospective Cohort Study at an Academic Center in Saudi Arabia

Al-Wassia¹,

Bamehrez²,

Basamh³

et al. 2023

Cureus

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Background and objectiveNecrotizing enterocolitis (NEC) is a detrimental complication of the gastrointestinal tract among preterm infants with very low birth weight (VLBW) and is associated with high morbidity and mortality. About onethird of these cases require surgical intervention due to intestinal perforation. The preferred method for the surgical management of perforated NEC is still a matter of controversy. In light of this, we aimed to compare the outcomes of treating perforated NEC in VLBW infants with primary peritoneal drainage (PPD) versus laparotomy. MethodWe conducted a retrospective chart review of VLBW infants with perforated NEC treated at King Abdulaziz

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Primary Peritoneal Drainage Versus Laparotomy for Perforated Necrotizing Enterocolitis in Very-Low-Birth-Weight Infants: A Retrospective Cohort Study at an Academic Center in Saudi Arabia

Al-Wassia¹,

Bamehrez²,

Basamh³

et al. 2023

Cureus

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“…Although not statistically significant, peritoneal drainage was employed more frequently in PT patients (22.4%) than in the TC group (4.4%). This likely reflects a practice pattern at our institution where patients are approached differently based on their gestational age and weight at the time of diagnosis, which is similar to the strategy utilized at other centers (18)(19)(20).…”

Section: Discussionmentioning

confidence: 87%

Comparison of Necrotizing Enterocolitis in Pre-mature Infants vs. Term-Born Infants With Congenital Heart Disease

et al. 2021

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Purpose: Necrotizing enterocolitis (NEC) is a serious illness that occurs among premature infants and term-born infants with congenital heart disease (CHD). Prior studies have suggested these two groups may experience different disease entities. We sought to evaluate if there are differences in disease characteristics between these two populations.Materials and Methods: A retrospective chart review of infants treated for Bells stage 2-3 NEC from 2011 to 2020 was performed. Demographic information, CHD diagnoses and clinical data were recorded. Prior to data analysis, patients were divided into two groups: term-born patients with CHD (TC) and premature patients without CHD (PT).Results: 99 patients were analyzed−23 TC patients and 76 PT patients. Platelet counts (222.7 ± 176.1 vs. 310.2 ± 174.5 cells/uL, P = 0.03) and C-reactive protein (CRP) levels (53.6 ± 81.7 vs. 117.6 ± 90.4 mg/L, P < 0.001) were significantly higher among the PT group. In addition, PT patients were more likely to develop pneumatosis (30.4 vs. 68.4%, P = 0.002) than TC patients. NEC-specific mortality was similar between both groups of patients.Conclusions: When compared to TC patients, PT patients had higher CRP levels, higher platelet counts and more commonly developed pneumatosis. These factors may point toward a difference in disease pathophysiology regarding NEC development in premature patients vs. term-born patients with CHD.

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“…To address this bias, we excluded infants who were diagnosed with FIP at surgery or autopsy, as well as those presumed to have FIP as determined by the care team based on the infant’s clinical course. Our methodology was similar to prior studies of surgical NEC patients [ 3 , 17 ]. However, contamination with FIP is still possible, as 25% of infants with s NEC were diagnosed at a week or younger of age, a timeframe more consistent with FIP [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of a multi-institution cohort of infants with necrotizing enterocolitis totalis

et al. 2021

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Objective To characterize the presentation, management and outcomes of infants with necrotizing enterocolitis totalis ( t NEC) vs surgical non-totalis NEC ( s NEC). Study design This retrospective study identified infants undergoing surgery for NEC through The Children’s Hospitals Neonatal Database. Demographic, surgical and mortality characteristics were compared. Results Of 1059 infants, 161 (15.2%) had t NEC. Perinatal characteristics did not differ. t NEC infants were older and were less likely to have pneumoperitoneum at referral (5.6% vs 13.1%, p < 0.001) or intestinal perforation at surgery (38.5% vs 66.7%, p < 0.001). Infants with t NEC were more acidotic preoperatively (7.1, [IQR 7, 7.3] vs 7.3, [IQR 7.2, 7.4], p < 0.001). Mortality was 96.9% for t NEC and 26.5% for s NEC ( p < 0.001). t NEC cases varied by center, accounting for 0–43% of all surgical NEC cases. Conclusions Mortality is high for t NEC infants, who present at older age, with greater illness severity but are less likely to have intestinal perforation than s NEC infants.

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Does the initial surgery for necrotizing enterocolitis matter? Comparative outcomes for laparotomy vs. peritoneal drain as initial surgery for necrotizing enterocolitis in infants < 1000 g birth weight

Cited by 12 publications

References 23 publications

Primary Peritoneal Drainage Versus Laparotomy for Perforated Necrotizing Enterocolitis in Very-Low-Birth-Weight Infants: A Retrospective Cohort Study at an Academic Center in Saudi Arabia

Primary Peritoneal Drainage Versus Laparotomy for Perforated Necrotizing Enterocolitis in Very-Low-Birth-Weight Infants: A Retrospective Cohort Study at an Academic Center in Saudi Arabia

Comparison of Necrotizing Enterocolitis in Pre-mature Infants vs. Term-Born Infants With Congenital Heart Disease

Characteristics and outcomes of a multi-institution cohort of infants with necrotizing enterocolitis totalis

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Does the initial surgery for necrotizing enterocolitis matter? Comparative outcomes for laparotomy vs. peritoneal drain as initial surgery for necrotizing enterocolitis in infants < 1000 g birth weight

Cited by 12 publications

References 23 publications

Primary Peritoneal Drainage Versus Laparotomy for Perforated Necrotizing Enterocolitis in Very-Low-Birth-Weight Infants: A Retrospective Cohort Study at an Academic Center in Saudi Arabia

Primary Peritoneal Drainage Versus Laparotomy for Perforated Necrotizing Enterocolitis in Very-Low-Birth-Weight Infants: A Retrospective Cohort Study at an Academic Center in Saudi Arabia

Comparison of Necrotizing Enterocolitis in Pre-mature Infants vs. Term-Born Infants With Congenital Heart Disease

Characteristics and outcomes of a multi-institution cohort of infants with necrotizing enterocolitis totalis

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Does the initial surgery for necrotizing enterocolitis matter? Comparative outcomes for laparotomy vs. peritoneal drain as initial surgery for necrotizing enterocolitis in infants < 1000 g birth weight