Early postoperative outcomes of surgery for intestinal perforation in NEC based on intestinal location of disease

Geng, Qiankun; Wang, Yongming; Li, Lei; Guo, Chunbao

doi:10.1097/md.0000000000012234

Cited by 15 publications

(8 citation statements)

References 24 publications

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“…36 cm, p <0.01). The ileocecal region was affected in a majority, which is consistent with previous reports ( 10 , 23 ). This region, particularly the ileum, is highly susceptible due to its low vascularity and high metabolic demands ( 31 ).…”

Section: Discussionsupporting

confidence: 92%

Incomplete resection of necrotic bowel may increase mortality in infants with necrotizing enterocolitis

et al. 2020

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Background: Infants with advanced NEC often need surgical resection of necrotic bowel. We hypothesized that incomplete resection of NEC lesions, signified by the detection of necrotic patches in margins of resected bowel loops, results in inferior clinical outcomes. Methods: We reviewed the medical records of infants with surgical NEC in the past 15 years for demographic, clinical, and histopathological data. We also developed statistical models to predict mortality and hospital stay. Results: Ninety infants with surgical NEC had mean (± standard error) gestational age 27.3±0.4 weeks, birth weight 1008±48 g, NEC onset at 25.2±2.4 days, and resected bowel length of 29.2±3.2 cm. Seventeen (18.9%) infants who had complete resection of the necrosed bowel had fewer (4; 23.5%) deaths and shorter lengths of hospital stay. In contrast, a group of 73 infants with some necrosis within the margins of resected bowel had significantly more (34; 46.6%) deaths and longer hospital stay. The combination of clinical and histopathological data gave better regression models for mortality and hospital stay. Conclusion: In surgical NEC, incomplete resection of necrotic bowel increased mortality and the duration of hospitalization. Regression models combining clinical and histopathological data were more accurate for mortality and the length of hospital stay.

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Section: Discussionsupporting

confidence: 92%

Incomplete resection of necrotic bowel may increase mortality in infants with necrotizing enterocolitis

et al. 2020

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“…The overall mortality rate in infants treated with PD was 66.6%. This result is comparable to ndings of other studies reporting mortality rates between 60.5% and 38% (29,30). A randomized controlled trial showed no survival bene t compared PD with primary laparotomy (31).…”

Section: Discussionsupporting

confidence: 87%

Influence of birth weight on surgical outcomes in infants with necrotizing enterocolitis.

Zahradníková

Fědorová

et al. 2022

Preprint

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Background: NEC is a leading cause of mortality and morbidity in extremely low birth weight (ELBW) infants. The primary aim of the study was to evaluate the risk factors for surgical NEC in ELBW infants, and the second goal was to find out post-operative complications, with specific emphasis on stoma related complications. Methods: A retrospective analysis of surgically treated NEC during the 20-year period from 2001-2020 in a single-center was performed. Postoperative complications were classified according to the Clavien-Dindo Classification (CDC). Patients were divided into 2 groups according to birth weight: ELBW (birth weight ≤ 1000 g) and VLBW (very low birth weight ≤ 1500 g). Results: A total of 97 patients meet the pre-determined eligibility criteria and were included in the study. The proportion of male infants in the ELBW was significantly higher than in VLBW group, (odd ratio [OR] = 5.54 [95% CI, 1.68-14.38]; p = 0.003). Lower Apgar score (AS) in the 1 minute in the ELBW group was significantly associated with the NEC progression (p ˂ 0.001). Stoma creation was more often used in the ELBW than in VLBW group (OR = 4.571 [95% CI, 1.186-16.11]; p =0.023). A total of 49 (72%) infants had postsurgical complication, which was significant greater in the ELBW 44/50 (88%) than the VLBW group 5/18 (27.78%) (OR = 19.07 [95% CI, 4.669-77.09]; p˂ 0.0001). In total, 22 out of 40 ELBW infants with enterostomy (55%) had at least one stoma complication. The overall rate of mortality (CDC: V) was 25/68 patients (36.7%). There was nonsignificant difference between the 2 groups regarding the mortality rate (p = 0.406). Conclusions: Our results showed that the risk factors associated with the surgical NEC in ELBW infants include low birth weight, low gestational age, male gender, and low AS in 1 minute. ELBW infants had a higher complication rate and most of them required reoperation. The type of stoma configuration had no impact on the complication rate. Mortality rate was not affected by the birthweight.

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“…Surgical methods: Current surgical strategies for necrotizing enterocolitis (NEC) include primary drainage, resection with enterostomies, and primary anastomosis. The research shows, the postoperative outcomes in newborns undergoing laparotomy were associated with the surgical type, which was determined by disease location in the bowel [ 155 ]. There are also different practices in how to avoid damage to the intestinal wall and how to deal with residuals in the intestinal cavity during surgery.…”

Section: Treatment Of Necmentioning

confidence: 99%

Necrotizing enterocolitis: current understanding of the prevention and management

Hu,

Liang,

et al. 2024

Pediatr Surg Int

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Necrotizing enterocolitis (NEC) is one of the diseases in neonates, with a high morbidity and mortality rate, especially in preterm infants. This review aimed to briefly introduce the latest epidemiology, susceptibility factors, and clinical diagnosis and presentation of NEC. We also organized new prevention strategies by risk factors according to different pathogeneses and then discussed new treatment methods based on Bell's staging and complications, and the classification of mild to high severity based on clinical and imaging manifestations. Such a generalization will help clinicians and researchers to gain a deeper understanding of the disease and to conduct more targeted classification, grading prevention, and exploration. We focused on prevention and treatment of the early and suspected stages of NEC, including the discovery of novel biomarkers and drugs to control disease progression. At the same time, we discussed its clinical application, future development, and shortcomings.

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Early postoperative outcomes of surgery for intestinal perforation in NEC based on intestinal location of disease

Cited by 15 publications

References 24 publications

Incomplete resection of necrotic bowel may increase mortality in infants with necrotizing enterocolitis

Incomplete resection of necrotic bowel may increase mortality in infants with necrotizing enterocolitis

Influence of birth weight on surgical outcomes in infants with necrotizing enterocolitis.

Necrotizing enterocolitis: current understanding of the prevention and management

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