Exploratory laparotomy in the management of confirmed necrotizing enterocolitis. Issue 2 (April 2015)

• Record Type: Journal Article
• Authors: Lakhoo, Kokila; Morgan, Robert D.; Thakkar, Hemanshoo; Gupta, Amit; Grant, Hugh W.; Wagener, Silke; Willetts, Ian E.
• Is Part Of: Annals of pediatric surgery. Volume 11:Issue 2(2015)
• Publication Date: 2015-04
• Subjects: Children -- Surgery -- Periodicals; Pediatrics -- Periodicals; Surgical Procedures, Operative -- Periodicals; Pediatrics -- Periodicals; Children -- Surgery; Pediatrics; Periodicals; 617.98005
• DOI: 10.1097/01.XPS.0000463166.88394.24
• Languages: English
• ISSNs: 2090-5394

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Introduction</title> <p>Necrotizing enterocolitis (NEC) is a serious gastrointestinal emergency in newborn infants. Surgical management includes primary peritoneal drainage and/or exploratory laparotomy with bowel resection. This study describes obstetric complications, postnatal comorbidities, surgical care and intermediate postoperative outcomes in all infants with surgically and/or histologically proven NEC, who underwent exploratory laparotomy at our tertiary referral centre.</p> </sec> <sec> <title>Materials and methods</title> <p>We conducted a retrospective review between January 2005 and December 2010. Results are reported as median (range). Fisher's exact test (two tailed) was used for statistical analysis. A <italic>P</italic>-value of 0.05 or less was considered statistically significant.</p> </sec> <sec> <title>Results</title> <p>A total of 71 infants had suspected (Bell's stage≥1) NEC. Of them, 32 infants underwent laparotomy for stage 2–3 NEC. We excluded 11 infants with surgically and/or histologically proven spontaneous intestinal perforation. In the remaining 21 infants with confirmed NEC, median gestational age was 27 weeks (23–39 weeks) and median birth weight was 720 g (440–3510 g). NEC was suspected after a median 14 days of life (1–49 days of life). Fifteen patients (71%) were initially managed medically for a median total of 8 days (1–25 days). Laparotomy was performed after a median of 7 days (<1–35 days) from the suspicion of NEC. Eleven infants (52%) underwent bowel resection and enterostomy, four infants (19%) underwent bowel resection with primary anastomosis and one infant (5%) underwent proximal diverting jejunostomy. Bowel perforation was seen in seven patients (33%). Necrosis totalis was evident in five patients (24%). There were 12 postoperative deaths (57% mortality), and seven deaths (58%) occurred during the first 30 days. Infants who died were more likely to have had absent/reversed end-diastolic flow (<italic>n</italic>=5, <italic>P</italic>=0.64), intrauterine growth retardation (<italic>n</italic>=5, <italic>P</italic>=0.18) or a gestational birth weight between 501 and 750 g (<italic>n</italic>=9, <italic>P</italic>=0.08). In the surviving children (<italic>n</italic>=9), the median length of hospital stay was 134 days (87–190 days) and postoperative sequelae were frequently seen.</p> </sec> <sec> <title>Conclusion</title> <p>The morbidity and mortality for infants with confirmed NEC who undergo laparotomy remain high in infants despite optimal medical and surgical care.</p> </sec> </abstract>