Predictive factors for surgical treatment in preterm neonates with necrotizing enterocolitis: a multicenter case-control study

Abstract

Necrotizing enterocolitis (NEC) is one of the most common and lethal gastrointestinal diseases in preterm infants. Early recognition of infants in need for surgical intervention might enable early intervention. In this multicenter case-control study, performed in nine neonatal intensive care units, preterm born infants (< 30 weeks of gestation) diagnosed with NEC (stage ≥ IIA) between October 2014 and August 2017 were divided into two groups: (1) medical (conservative treatment) and (2) surgical NEC (sNEC). Perinatal, clinical, and laboratory parameters were collected daily up to clinical onset of NEC. Univariate and multivariate logistic regression analyses were applied to identify potential predictors for sNEC. In total, 73 preterm infants with NEC (41 surgical and 32 medical NEC) were included. A low gestational age (p value, adjusted odds ratio [95%CI]; 0.001, 0.91 [0.86–0.96]), no maternal corticosteroid administration (0.025, 0.19 [0.04–0.82]), early onset of NEC (0.003, 0.85 [0.77–0.95]), low serum bicarbonate (0.009, 0.85 [0.76–0.96]), and a hemodynamically significant patent ductus arteriosus for which ibuprofen was administered (0.003, 7.60 [2.03–28.47]) were identified as independent risk factors for sNEC.Conclusions: Our findings may support the clinician to identify infants with increased risk for sNEC, which may facilitate early decisive management and consequently could result in improved prognosis. What is Known:• In 27–52% of the infants with NEC, a surgical intervention is indicated during its disease course.• Absolute indication for surgical intervention is bowel perforation, whereas fixed bowel loop or clinical deterioration highly suggestive of bowel perforation or necrosi, is a relative indication. What is New:• Lower gestational age, early clinical onset, and no maternal corticosteroids administration are predictors for surgical NEC.• Low serum bicarbonate in the 3 days prior clinical onset and patent ductus arteriosus for which ibuprofen was administered predict surgical NEC.

Predictive Factors for Surgical Intervention in Neonates with Necrotizing Enterocolitis: A Retrospective Study

“…They also found that a lower gestational age is an independent risk factor for increased 28-day mortality or parenteral nutrition requirement (adjusted OR: 0.85, 95% CI, 0.77-0.94, p = 0.001). In addition, a recent published multicenter study demonstrated an adjusted OR of 0.91 (95% CI, 0.86-0.96, p = 0.001) in gestational age for the need for surgical intervention (19). This inverse association is in accordance with the result in our study, despite the fact that they included birth weight and maternal corticosteroid in their multivariate logistic model, but only PCT was included in our final model.…”

Predictive factors for rapid progression in preterm neonates with necrotizing enterocolitis

“…The definition of fulminant NEC has been found to be inconsistent in previous studies. Fulminant NEC is defined as death due to NEC within 48 h following diagnosis ( 4 ), as NEC-totalis or death within 72 h of diagnosis ( 2 ), or as pan-intestinal necrosis or death within 48 h of onset ( 5 ). A rapid increase in feeding volume, increased concentration of milk fortifiers, lower birth weight, and earlier gestational age seem to be the risk factors for fulminant NEC.…”

Development of artificial neural networks for early prediction of intestinal perforation in preterm infants

“…Many previous studies have investigated the risk factors and pathogenesis of these two types of IP. According to the literature, possible risk factors include prematurity, low birth weight, perinatal use of medications (ibuprofen, steroids, indomethacin, and inotropic agents), maternal chorioamnionitis, patent ductus arteriosus (PDA), and high-grade intraventricular hemorrhage (IVH grade III or IV) 5 , 7 – 22 . Despite these efforts, due to the nature of retrospective studies with a small number of patients, there is thus far no consensus concerning risk factors.…”