Gastrointestinal sequelae after surgery for necrotising enterocolitis: a systematic review and meta-analysis. Issue 3 (26th May 2019)

• Record Type: Journal Article
• Authors: Hau, Eva-Maria; Meyer, Sarah C; Berger, Steffen; Goutaki, Myrofora; Kordasz, Marcin; Kessler, Ulf
• Is Part Of: Archives of disease in childhood. Volume 104:Issue 3(2019)
• Page Start: F265
• Publication Date: 2019-05-26
• Subjects: sequelae -- necrotising enterocolitis -- NEC -- outcome; Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2017-314435
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Objectives: To document what types of gastrointestinal sequelae were described after surgery for necrotising enterocolitis (NEC) and to analyse their frequency. Design: Systematic review and meta-analysis. Data sources: Medline, EMBASE and the Cochrane library (CENTRAL) from 1990 to October 2016. Eligibility criteria for selecting studies: We included studies, which provided original data on the occurrence of gastrointestinal sequelae in patients surviving surgery for NEC. Meta-analysis and metaregression to assess heterogeneity were performed for studies including 10 or more patients with gastrointestinal strictures, recurrence of NEC, intestinal failure (IF) and adhesion ileus. Results: Altogether 58 studies, including 4260 patients, met the inclusion criteria. Strictures were reported to occur in 24% (95% CI 17% to 31%) of surviving patients, recurrence of NEC in 8% (95% CI 3% to 15%), IF in 13% (95% CI 7% to 19%) and adhesion ileus in 6% (95% CI 4% to 9%). Strictures were more common following enterostomy (30%; 95% CI 23% to 37%) than after primary anastomosis (8%; 95% CI 0% to 23%) and occurred more often after enterostomy without bowel resection than with bowel resection. We found considerable heterogeneity in the weighted average frequency of all sequelae (I 2 range: 38%–90%). Intestinal outcomes were poorly defined, there were important differences in study populations and designs, and the reported findings bear a substantial risk of bias. Conclusions: Gastrointestinal sequelae in neonates surviving surgery for NEC are frequent. Long-term follow-up assessing defined gastrointestinal outcomes is warranted.