Surgical necrotizing enterocolitis: Association between surgical indication, timing, and outcomes
Surgical necrotizing enterocolitis: Association between surgical indication, timing, and outcomes
Background/Purpose: Despite improvements in neonatal care the outcomes of Necrotizing Enterocolitis (NEC) remain unchanged over previous decades. The study aims to explore whether different indications for surgical intervention in NEC are associated with timing of surgery and outcomes. Methods: Population-based, prospective, observational study of all 27 paediatric surgical centres in the United Kingdom and Ireland identified using the British Association of Paediatric Surgeons Congenital Anomalies Surveillance System from 1st February 2013 to 28th February 2014. Infants were included if they had NEC and underwent first surgical intervention within 7 days of diagnosis. Primary outcomes were death, parenteral nutrition requirement or a composite outcome of death or PN requirement at 28 days post surgery. Results: There were 133 infants meeting inclusion criteria. Indications for surgery were bowel perforation (n = 67), suspected necrotic bowel without bowel perforation and not deemed to have failed medical management (n = 20), those who had failed medical management (n = 42) and a palpable mass without any other indication (n = 4). Failed medical treatment as an indication for surgery was associated with an increased time to surgery of 30.28 (95% CI 13.46–47.10) hours from those whose indication was perforation and was also the strongest predictor of PN requirement or death at 28 days post-surgery (OR 4.54 [1.59–13.0]). Conclusions: Failed medical treatment as an indication for surgery for NEC is associated with poor outcome. Earlier intervention in these infants represents a potential opportunity to improve outcomes in this population.
Necrotizing enterocolitis, Neonatology, Surgical decision making
1785-1790
Bethell, George S.
9c442b15-1e62-4b7a-8334-85024c37ecc2
Knight, Marian
7cfa08c5-3235-4c6c-b5f9-aa784379d4e0
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
October 2021
Bethell, George S.
9c442b15-1e62-4b7a-8334-85024c37ecc2
Knight, Marian
7cfa08c5-3235-4c6c-b5f9-aa784379d4e0
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
Bethell, George S., Knight, Marian and Hall, Nigel
(2021)
Surgical necrotizing enterocolitis: Association between surgical indication, timing, and outcomes.
Journal of Pediatric Surgery, 56 (10), .
(doi:10.1016/j.jpedsurg.2021.04.028).
Abstract
Background/Purpose: Despite improvements in neonatal care the outcomes of Necrotizing Enterocolitis (NEC) remain unchanged over previous decades. The study aims to explore whether different indications for surgical intervention in NEC are associated with timing of surgery and outcomes. Methods: Population-based, prospective, observational study of all 27 paediatric surgical centres in the United Kingdom and Ireland identified using the British Association of Paediatric Surgeons Congenital Anomalies Surveillance System from 1st February 2013 to 28th February 2014. Infants were included if they had NEC and underwent first surgical intervention within 7 days of diagnosis. Primary outcomes were death, parenteral nutrition requirement or a composite outcome of death or PN requirement at 28 days post surgery. Results: There were 133 infants meeting inclusion criteria. Indications for surgery were bowel perforation (n = 67), suspected necrotic bowel without bowel perforation and not deemed to have failed medical management (n = 20), those who had failed medical management (n = 42) and a palpable mass without any other indication (n = 4). Failed medical treatment as an indication for surgery was associated with an increased time to surgery of 30.28 (95% CI 13.46–47.10) hours from those whose indication was perforation and was also the strongest predictor of PN requirement or death at 28 days post-surgery (OR 4.54 [1.59–13.0]). Conclusions: Failed medical treatment as an indication for surgery for NEC is associated with poor outcome. Earlier intervention in these infants represents a potential opportunity to improve outcomes in this population.
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Accepted/In Press date: 25 April 2021
e-pub ahead of print date: 2 May 2021
Published date: October 2021
Additional Information:
Funding Information:
This project was funded through a National Institute for Health Research (NIHR) Professorship award to Marian Knight ( NIHR-RP-011-032 ). Professor Knight is a National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. George Bethell is funded by the National Institute of Heath Research Academic Clinical Fellow programme.
Publisher Copyright:
© 2021
Keywords:
Necrotizing enterocolitis, Neonatology, Surgical decision making
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Local EPrints ID: 448830
URI: http://eprints.soton.ac.uk/id/eprint/448830
ISSN: 0022-3468
PURE UUID: 96d3b053-0cf3-4bd4-a965-1b6e30acd819
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Date deposited: 06 May 2021 16:32
Last modified: 17 Mar 2024 03:24
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Author:
George S. Bethell
Author:
Marian Knight
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