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J Perinatol. 2014 Oct;34(10):736-40. doi: 10.1038/jp.2014.153. Epub 2014 Aug 21.

Short-term outcomes for preterm infants with surgical necrotizing enterocolitis.

Author information

1
Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University Chicago, Chicago, IL, USA.
2
Children's Hospital of Pittsburgh and the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
3
Department of Pediatrics, University of Utah and the Primary ChildreĊ„s Medical Center, Salt Lake City, UT, USA.
4
Children's Healthcare of Atlanta at Egleston and the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
5
Children's Hospital Association, Inc., Overland Park, KS, USA.
6
Children's Mercy Hospitals & Clinics, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.
7
1] Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA [2] Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA.
8
Children's Medical Center and the Department of Pediatrics, University of Texas-Southwestern Medical Center, Dallas, TX, USA.
9
Children's Hospital of Philadelphia and the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
10
Department of Pediatrics, University of South Florida and the Florida Hospital for Children, Orlando, FL, USA.
11
Department of Pediatrics, Children's Hospital Oakland & Research Center, Neonatal/Pediatric Research, Oakland, CA, USA.
12
Children's National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
13
Department of Pediatrics, Children's Hospital Oakland & Research Center, Oakland, CA, USA.
14
Nationwide Children's Hospital and the Department of Pediatrics at The Ohio State University College of Medicine, Columbus, OH, USA.

Abstract

OBJECTIVE:

To characterize the population and short-term outcomes in preterm infants with surgical necrotizing enterocolitis (NEC).

STUDY DESIGN:

Preterm infants with surgical NEC were identified from 27 hospitals over 3 years using the Children's Hospitals Neonatal Database; infants with gastroschisis, volvulus, major congenital heart disease or surgical NEC that resolved prior to referral were excluded. Patient characteristics and pre-discharge morbidities were stratified by gestational age (<28 vs 28(0/7) to 36(6/7) weeks' gestation).

RESULT:

Of the 753 eligible infants, 60% were born at <28 weeks' gestation. The median age at referral was 14 days; only 2 infants were inborn. Male gender (61%) was overrepresented, whereas antenatal steroid exposure was low (46%). Although only 11% had NEC totalis, hospital mortality (<28 weeks' gestation: 41%; 28(0/7) to 36(6/7) weeks' gestation: 32%, P=0.02), short bowel syndrome (SBS)/intestinal failure (IF) (20% vs 26%, P=0.06) and the composite of mortality or SBS/IF (50% vs 49%, P=0.7) were prevalent. Also, white matter injury (11.7% vs 6.6%, P=0.02) and grade 3 to 4 intraventricular hemorrhages (23% vs 2.7%, P<0.01) were commonly diagnosed. After referral, the median length of hospitalization was longer for survivors (106 days; interquartile range (IQR) 79, 152) relative to non-survivors (2 days; IQR 1,17; P<0.001). These survivors were prescribed parenteral nutrition infrequently after hospital discharge (<28 weeks': 5.2%; 28(0/7) to 36(6/7) weeks': 9.9%, P=0.048).

CONCLUSION:

After referral for surgical NEC, the short-term outcomes are grave, particularly for infants born <28 weeks' gestation. Although analyses to predict outcomes are urgently needed, these data suggest that affected infants are at a high risk for lengthy hospitalizations and adverse medical and neuro-developmental abnormalities.

Comment in

PMID:
25144157
DOI:
10.1038/jp.2014.153
[Indexed for MEDLINE]
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