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Minerva Chirurgica 2017 June;72(3):183-7

DOI: 10.23736/S0026-4733.17.07159-0


language: English

Multicenter retrospective study on management and outcome of newborns affected by surgical necrotizing enterocolitis

Silvana FEDERICI 1, Lorenzo DE BIAGI 1, Simona STRAZIUSO 1, Ernesto LEVA 2, Giulia BRISIGHELLI 2, Girolamo MATTIOLI 3, Luca PIO 3, Pietro BAGOLAN 4, Giorgia TOTONELLI 4, Bruno NOCCIOLI 5, Elisa SEVERI 5, Pierluigi LELLI CHIESA 6, 7, Gabriele LISI 6, 7, Antonino TRAMONTANO 8, Carolina DE CHIARA 8, Carmine DEL ROSSI 9, Giovanni CASADIO 9, Mario MESSINA 10, Rossella ANGOTTI 10, Antonino APPIGNANI 11, Mirko BERTOZZI 11, Fabio ROSSI 12, Valeria GABRIELE 12, Andrea FRANCHELLA 13, Veronica ZOCCA 13

1 Pediatric Surgery Unit, Infermi Hospital, Rimini, Italy; 2 Pediatric Surgery Department, IRCCS Ca’ Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy; 3 Pediatric Surgery Unit, Giannina Gaslini Institute, Genoa, Italy; 4 Medical and Surgical Neonatology Department, Bambin Gesù Children’s Hospital, Rome, Italy; 5 Neonatal Surgery Unit, Meyer University Children’s Hospital, Florence, Italy; 6 Pediatric Surgery Department, G. d’Annunzio University of Chieti-Pescara, Chieti, Italy; 7 Pediatric Surgery Unit, Spirito Santo Hospital, Pescara, Italy; 8 Neonatal Surgical Unit, Santobono Children’s Hospital, Naples, Italy; 9 Pediatric Surgery Unit, Maggiore University Hospital of Parma, Parma, Italy; 10 Pediatric Surgery Unit, Department of Medical Sciences, Surgery, and Neuroscience, University of Siena, Siena, Italy; 11 Pediatric Surgery Unit, University of Perugia, Perugia, Italy; 12 Pediatric Surgery Department, Ospedale Maggiore della Carità, Novara, Italy; 13 Pediatric Surgery Department, Sant’Anna Hospital, Cona, Ferrara, Italy

BACKGROUND: Necrotizing enterocolitis (NEC) is the most common surgical emergency in newborns and it is still a leading cause of death despite the improvements reached in the management of the critically ill neonate. The purpose of this study was to evaluate risk factors, surgical treatments and outcome of surgical NEC.
METHODS: We retrospectively evaluated a multicentric group of 184 patients with surgical NEC over a period of 5 years (2008-2012). Indications to operation were modified NEC Bell stages IIIA or IIIB. The main outcome was measured in terms of survival and postsurgical complications.
RESULTS: Data on 184 patients who had a surgical NEC were collected. The majority of patients (153) had a primary laparotomy (83%); 10 patients had peritoneal drainage insertion alone (5%) and 21 patients had peritoneal drainage followed by laparotomy (12%). Overall mortality was 28%. Patients with lower gestational age (P=0.001), lower birth weight (P=0.001), more extensive intestinal involvement (P=0.002) and cardiac diseases (P=0.012) had a significantly higher incidence of mortality. There was no statistically significant association between free abdominal air on the X-ray and mortality (P=0.407). Mortality in the drainage group was 60%, in the laparotomy group and drainage followed by laparotomy group was of 23-24% (P=0.043). There was a high incidence of stenosis (28%) in the drainage group (P=0.002). On multivariable regression, lower birth weight, feeding, bradycardia-desaturation and extent of bowel involvement were independent predictors of mortality.
CONCLUSIONS: Laparotomy was the most frequent method of treatment (83%). Primary laparotomy and drainage with laparotomy groups had similar mortalities (23-24%), while the drainage alone treatment cohort was associated with the highest mortality (60%) with statistical value (P=0.043). Consequently laparotomy is highly protective in terms of survival rate. Stenosis seemed to be statistically associated with drainage. These findings could discourage the use of peritoneal drainage versus a primary laparotomy whenever the clinical conditions of patients allow this procedure.

KEY WORDS: Enterocolitis, necrotizing - Drainage - Laparotomy - Mortality - Constriction, pathologic

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