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

Abstract

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.

Intestinal Resection is More Likely to be Effective in Necrotizing Enterocolitis Extending to Colon than in Disease Limited to the Small Intestine

“…All showed findings of NEC, including necrosis, inflammation, and hemorrhages, and some showed regenerative changes. Consistent with our earlier observations, 17 necrosis, inflammatory changes, and hemorrhages correlated with each other. Pneumatosis was seen in about 30% of the sections.…”

“…We have recently shown that incomplete resections of necrotic bowel may increase mortality in NEC. 17 There may be some justification for on-site, rapid histopathological screening of the resected tissues to prevent excessive removal of segments that could possibly recover in time, but also to ensure that all clearly necrotic patches have been removed.…”

“…In this group, 90 infants have been previously described. 17 The 153 infants included in this study had an average gestational age (mean ± SD; ± SEM) of 27.4 ± 3.4 weeks (±0.3 weeks SEM) and a birth weight of 987 ± 505 g (±40.8 g SEM). Eighty-seven (56.8%) were outborn.…”

“…Again, considering the relatively low incidence of surgical NEC, a retrospective study format seemed reasonable provided we could carefully record information from all possible medical, surgical, and nursing records. We have recently described 90 infants who were treated at UMMC for surgical NEC during the years 2000–2015, 5 , 17 and an extension of the study period to 2018 provided an adequate number of patients (as described in methods). As may be evident in the tables, we reviewed clinical records and histopathology sections from all infants, and gross pathology specimens from most patients.…”

Clinical Correlates of Moderate-to-Severe Bronchopulmonary Dysplasia in Preterm Infants following Surgical Necrotizing Enterocolitis

“…We previously reported that incomplete resection of inflamed intestine was associated with longer hospital stay and mortality than complete resection. 31 The reasons and mechanisms leading to greater severity of BPD in pre-term infants are still not fully understood. Toll-like receptor 4 activation by LPS has been associated with NEC in animal model studies.…”