Abstract | PURPOSE: METHODS: This is a retrospective review of neonates diagnosed with NEC who underwent a laparotomy on NICU between 2001 and 2011. Demographic, diagnostic, operative and outcome data were analysed. Nonparametric comparison was used. Data are reported as median (range). RESULTS: 221 infants with NEC were referred for surgical evaluation; 182 (82%) underwent surgery; 15 (8%) required a laparotomy on NICU. Five had NEC totalis, 4 multifocal disease and 6 focal disease. Five had an open and close laparotomy, 8 stoma with/without bowel resection and 2 bowel resection and primary anastomosis. Ten (67%) died at a median of 6.5-hours (2-72) postoperatively; 2 died at 72 and 264-days. The 30-day mortality rate was higher (p=0.01) among infants undergoing a laparotomy on NICU (10/15; 67%) than in theatre (54/167; 32%). There was no significant difference in mean Paediatric Index of Mortality 2 Scores between survivors and nonsurvivors (p=0.55). Three (20%) infants remain alive with no or minimal disability at 1.4 (0.5-7.5) years. CONCLUSION:
Laparotomy for NEC on NICU is a treatment option for neonates who are too unstable to transfer to theatre. However, with 67% dying within 6.5-hours and a further 13% after months in hospital, we must consider whether surgery is always in their best interests. Development of a prediction model to help distinguish those at highest risk of long-term morbidity and mortality could help with decision making in this difficult situation.
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Authors | Naomi J Wright, Mandela Thyoka, Edward M Kiely, Agostino Pierro, Paolo De Coppi, Kate M K Cross, David D Drake, Mark J Peters, Joe I Curry |
Journal | Journal of pediatric surgery
(J Pediatr Surg)
Vol. 49
Issue 8
Pg. 1210-4
(Aug 2014)
ISSN: 1531-5037 [Electronic] United States |
PMID | 25092078
(Publication Type: Journal Article)
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Copyright | Copyright © 2014 Elsevier Inc. All rights reserved. |
Topics |
- Critical Illness
- Enterocolitis, Necrotizing
(surgery)
- Female
- Follow-Up Studies
- Forecasting
- Humans
- Infant
- Infant, Newborn
- Intensive Care Units, Neonatal
- Laparotomy
(methods)
- Male
- Postoperative Complications
(epidemiology)
- Retrospective Studies
- Treatment Outcome
- United Kingdom
(epidemiology)
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