Neonatal independent predictors of severe NEC

Purpose Necrotizing enterocolitis (NEC) is a severe neonatal disease. The present study aimed to identify factors predisposing the development of severe forms of NEC. Methods This retrospective study examined NEC patients in a single centre between 2002 and 2015. Data concerning clinical characteris...

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Bibliographic Details
Published in:Pediatric surgery international 2018-06, Vol.34 (6), p.663-669
Main Authors: Duci, Miriam, Fascetti-Leon, Francesco, Erculiani, Marta, Priante, Elena, Cavicchiolo, Maria Elena, Verlato, Giovanna, Gamba, Piergiorgio
Format: Article
Language:English
Subjects:
Gastrointestinal diseases
Medicine
Medicine & Public Health
Mortality
Necrosis
Newborn babies
Original Article
Pediatric Surgery
Pediatrics
Surgery
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Summary:Purpose Necrotizing enterocolitis (NEC) is a severe neonatal disease. The present study aimed to identify factors predisposing the development of severe forms of NEC. Methods This retrospective study examined NEC patients in a single centre between 2002 and 2015. Data concerning clinical characteristics, therapeutic management as well as short-term outcomes were collected. We compared the patients receiving successful medical treatment and those requiring surgical intervention. Patients who underwent surgery were distinguished in three subcategories. Bivariate and multivariate analyses were used for the statistical analysis. Results We identified 155 patients in the study period. 102 were treated conservatively and 53 required surgery. 8 received a primary peritoneal drainage, 31 received a drainage and a subsequent laparotomy and 14 received a laparotomy. Multivariate regression analysis identified a lower risk for surgery with a later onset and higher serum pH values, whereas an increased risk with higher C reactive Protein (CRP) levels at the onset. Pneumatosis intestinalis was identified as a protective factor. Overall mortality was 6.4%, with higher percentage in surgical NEC. Conclusion This study suggests that a later onset is a protective sign for the progression to surgery, whereas lower pH values and higher CRP levels are prognostic factors associated with the need for surgery. The line of treatment involving explorative laparotomy in case of perforation seems to be rewarded by low morbidity and mortality rate.
ISSN:0179-0358
1437-9813
DOI:10.1007/s00383-018-4261-1