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

Abstract

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.