The outcome of critically ill neonates undergoing laparotomy for necrotising enterocolitis in the neonatal intensive care unit: a 10-year review.

Abstract

PURPOSE:

To evaluate outcomes in critically ill neonates with necrotising enterocolitis (NEC) undergoing a laparotomy in the neonatal intensive care unit (NICU).

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.

• 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)
• 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)