Recent advances in our understanding of NEC diagnosis, prognosis and surgical approach
Recent advances in our understanding of NEC diagnosis, prognosis and surgical approach
Necrotising enterocolitis (NEC) remains a devasting condition that has seen limited improvement in outcomes in recent years. The incidence of the disease is increasing as more extremely premature infants survive. NEC is responsible for 1 in 10 neonatal deaths and up to 61% of survivors have significant neurodevelopmental delay. The aim of this review is to highlight recent advances in diagnosis, prognosis and surgical approach in this condition. Many recent studies have reported novel methods of diagnosis of NEC with the aim of earlier and more accurate identification. These include imaging and machine learning techniques. Prognostication of NEC is particularly important to allow earlier escalation of therapy. Around 25% of infants with NEC will require surgery and recent data has shown that time from disease onset to surgery is greater in infants whose indication for surgery is failed medical management, rather than pneumoperitoneum. This indication was also associated with worse outcomes compared to pneumoperitoneum. Ongoing research has highlighted several new methods of disease prognostication which includes differentiating surgical from medical NEC. Finally, recent randomised controlled trials in surgical technique are discussed along with the implications of these for practice. Further, high quality research utilising multi-centre collaborations and high fidelity data from electronic patient records is needed to address the issues discussed and ultimately improve outcomes in NEC.
decision making, necrotising enterocolitis, prognosis, prognostication, surgery
Bethell, George S.
c7a62cc1-5573-41f6-ae00-3c11e8219dd4
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
31 July 2023
Bethell, George S.
c7a62cc1-5573-41f6-ae00-3c11e8219dd4
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Bethell, George S. and Hall, Nigel J.
(2023)
Recent advances in our understanding of NEC diagnosis, prognosis and surgical approach.
Frontiers in Pediatrics, 11, [1229850].
(doi:10.3389/fped.2023.1229850).
Abstract
Necrotising enterocolitis (NEC) remains a devasting condition that has seen limited improvement in outcomes in recent years. The incidence of the disease is increasing as more extremely premature infants survive. NEC is responsible for 1 in 10 neonatal deaths and up to 61% of survivors have significant neurodevelopmental delay. The aim of this review is to highlight recent advances in diagnosis, prognosis and surgical approach in this condition. Many recent studies have reported novel methods of diagnosis of NEC with the aim of earlier and more accurate identification. These include imaging and machine learning techniques. Prognostication of NEC is particularly important to allow earlier escalation of therapy. Around 25% of infants with NEC will require surgery and recent data has shown that time from disease onset to surgery is greater in infants whose indication for surgery is failed medical management, rather than pneumoperitoneum. This indication was also associated with worse outcomes compared to pneumoperitoneum. Ongoing research has highlighted several new methods of disease prognostication which includes differentiating surgical from medical NEC. Finally, recent randomised controlled trials in surgical technique are discussed along with the implications of these for practice. Further, high quality research utilising multi-centre collaborations and high fidelity data from electronic patient records is needed to address the issues discussed and ultimately improve outcomes in NEC.
Text
NEC review - final accepted version
- Accepted Manuscript
Text
fped-11-1229850
- Version of Record
More information
Accepted/In Press date: 21 July 2023
e-pub ahead of print date: 31 July 2023
Published date: 31 July 2023
Additional Information:
Funding Information:
GB is funded by the National Institute of Heath Research Doctoral Fellowship programme (grant no. NIHR302541). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Publisher Copyright:
2023 Bethell and Hall.
Keywords:
decision making, necrotising enterocolitis, prognosis, prognostication, surgery
Identifiers
Local EPrints ID: 481952
URI: http://eprints.soton.ac.uk/id/eprint/481952
ISSN: 2296-2360
PURE UUID: e487fcc1-1f70-4b00-9554-b1f5d7fc7757
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Date deposited: 14 Sep 2023 16:33
Last modified: 18 Mar 2024 04:09
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Author:
George S. Bethell
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