The surgical management of necrotising enterocolitis (NEC)

Thakkar, Hemanshoo; Lakhoo, Kokila

doi:10.1016/j.earlhumdev.2016.03.002

Cited by 45 publications

(35 citation statements)

References 20 publications

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“…Despite reports of persistently high mortality in surgically treated NEC infants , laparotomy with bowel resection and stoma is still the standard surgical approach . However, alternative approaches are slowly finding their way into the literature and into clinical practice .…”

Section: Discussionmentioning

confidence: 99%

Surgical findings during exploratory laparotomy are closely related to mortality in premature infants with necrotising enterocolitis

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Surgical findings during exploratory laparotomy are closely related to mortality in premature infants with necrotising enterocolitis

et al. 2017

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“…In patients with Bell stage III NEC [5] or SIP, surgery is almost invariably required. Mortality in surgically treated NEC remains high ranging from 30% to 50% [6][7][8]. Because of extensive loss of small intestine and impaired motility of remaining intestine, surgery for NEC or SIP is accompanied with intestinal failure (IF) in as many as 42% of patients [9,10], and long periods of parenteral nutrition (PN) are required.…”

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confidence: 99%

Intestinal failure associated cholestasis in surgical necrotizing enterocolitis and spontaneous intestinal perforation

Karila

Anttila

Iber

et al. 2019

Journal of Pediatric Surgery

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a b s t r a c tBackground: Surgery for necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) is often complicated by intestinal failure (IF) and intestinal failure associated cholestasis (IFAC). Objective: Assessment of incidence, predictors, and mortality associated with IFAC in surgically treated NEC and SIP. Methods: A retrospective observational study based on hospital records during 1986-2014 in the two largest Finnish neonatal intensive care units was performed. IFAC was defined as conjugated bilirubin N 34 μmol/l (2.0 mg/dl) for ≥ two postoperative weeks while receiving parenteral nutrition (PN). Results: In total 225 patients underwent surgery for NEC (n = 142; 63%) or SIP (n = 83; 37%). Included were 57 survivors with ≥two weeks PN. Sixty-five (42%) patients developed IFAC. Two-year survival with IFAC was 80% and without IFAC 89% (p = 0.13). Of the 65 patients with IFAC, all eight with unresolved IFAC died in comparison to six of 57 (11%) whose IFAC resolved (p b 0.0001), while IFAC resolved in all survivors. Survival among patients with resolved IFAC was 89% and with unresolved IFAC (n = 8) 0%, (p b 0.0001). IFAC lasted for median 83 (IQR 45-120) days and correlated with the duration of PN (R2 = 0.16, p = 0.03), delay of starting enteral feeds (R2 = 0.12, p = 0.05) and PN lipid emulsion (RR = 1.0 (95% CI = 1.0-1.1) (p = 0.02). In multivariate logistic regression analysis, IFAC development associated with septicemias and reoperations. Conclusions: 42% of prematures who underwent surgery for NEC or SIP developed IFAC. Reoperations and septicemias increased the risk of IFAC. None of the patients with unresolved IFAC survived, but IFAC did not increase overall mortality. Type of study: Retrospective prognosis study. Level of evidence: Level II.

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“…Patients are observed closely for any signs of progression of the disease or decompensation. If there is clinical deterioration, or a concern for full-thickness intestinal ischemia or perforation, surgical intervention is warranted [11][12][13]. Post-operatively, supportive care and antibiotics are continued while observing these patients for clinical improvement before eventual return of enteral feeding.…”

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Variability in Antibiotic Regimens for Surgical Necrotizing Enterocolitis Highlights the Need for New Guidelines

Blackwood

Hunter

Grabowski

2017

Surgical Infections

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We found that there is a high degree of variability in the antibiotic regimen for the treatment of NEC, even within a single NICU, with no regimen appearing superior over another. As data emerge that demonstrate the adverse effects of antibiotic overuse, our findings highlight the need for guidelines in the antibiotic treatment of NEC and suggest that an abbreviated course of post-operative antibiotics may be safe.

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The surgical management of necrotising enterocolitis (NEC)

Cited by 45 publications

References 20 publications

Surgical findings during exploratory laparotomy are closely related to mortality in premature infants with necrotising enterocolitis

Surgical findings during exploratory laparotomy are closely related to mortality in premature infants with necrotising enterocolitis

Intestinal failure associated cholestasis in surgical necrotizing enterocolitis and spontaneous intestinal perforation

Variability in Antibiotic Regimens for Surgical Necrotizing Enterocolitis Highlights the Need for New Guidelines

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