Abstract
Purpose: Quantify short-term outcomes associated with initial surgery [laparotomy (LAP) vs. peritoneal drain (PD)] for necrotizing enterocolitis (NEC) in extremely-low-birth-weight (ELBW) infants. Methods: Using the Children's Hospitals Neonatal Database, we identified ELBW infants < 32 weeks’ gestation with surgical NEC (sNEC). Unadjusted and multivariable regression analyses were used to estimate the associations between LAP (or PD) and death/short bowel syndrome (SBS) and length of stay (LOS). Results: LAP was the more common initial procedure for sNEC (n = 359/528, 68%). Infants receiving LAP were older and heavier. Initial procedure was unrelated to death/SBS in both bivariate (LAP: 43% vs PD: 46%, p = 0.573) and multivariable analyses (OR = 0.89, 95% CI = 0.57, 1.38, p = 0.6). LAP was inversely related to mortality (29% vs. 41%, p < 0.007) in bivariate analysis, but not significant in multivariable analysis accounting for markers of preoperative illness severity. However, the association between LAP and SBS (14% vs. 5%, p = 0.012) remained significant in multivariable analyses (adjusted OR = 2.25, p = 0.039). LOS among survivors was unrelated to the first surgical procedure in multivariable analysis. Conclusion: ELBW infants who undergo LAP as the initial operative procedure for sNEC may be at higher risk for SBS without a clear in-hospital survival advantage or shorter hospitalization. Level of evidence: Level II.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 712-717 |
| Number of pages | 6 |
| Journal | Journal of pediatric surgery |
| Volume | 54 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 2019 |
Funding
Jeanette Asselin, David Durand (ex officio), Francine Dykes, Jacquelyn Evans (Chair), Karna Murthy, Michael Padula, Eugenia Pallotto, Theresa Grover, Beverly Brozanski, and Anthony Piazza, Kristina Reber and Billie Short are members of the Children's Hospitals Neonatal Consortium, Inc. For more information, please contact: [email protected], We are indebted to the following institutions that serve the infants and their families, and these institutions also have invested in and continue to participate in the Children's Hospital's Neonatal Database (CHND). The site sponsors/contributors for the CHND are also included: 1. Children's Healthcare of Atlanta, Atlanta, GA (Francine Dykes, Anthony Piazza) 2. Children's Healthcare of Atlanta at Scottish Rite (Gregory Sysyn) 3. Children's Hospital of Alabama, Birmingham, AL (Carl Coghill, Allison Black) 4. Le Bonheur Children's Hospital, Memphis, TN (Ramasubbareddy Dhanireddy) 5. Children's Hospital Boston, Boston, MA (Anne Hansen, Tanzeema Houssain) 6. Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL (Karna Murthy, Gustave Falciglia) 7. Cincinnati Children's Hospital, Cincinnati, OH (Beth Haberman, Breda Poindexter, Amy Nathan, Kristin Nelson, Paul Kingma, Stefanie Riddle, Stephanie Merhar, Heather Kaplan) 8. Nationwide Children's Hospital, Columbus, OH (Kristina Reber) 9. Children's Medical Center, Dallas, TX (Rashmin Savani, Luc Brion, Noorjahan Ali) 10. Children's Hospital Colorado, Aurora, CO (Theresa Grover) 11. Children's Hospital of Michigan, Detroit, MI (Girija Natarajan) 12. Cook Children's Health Care System, Fort Worth, TX (Jonathan Nedrelow, Annie Chi, Yvette Johnson) 13. Texas Children's Hospital, Houston, TX (Gautham Suresh) 14. Riley Children's Hospital, Indianapolis, IN (William Engle, Lora Simpson, Gregory Sokol, Rebecca Rose) 15. Children's Mercy Hospitals & Clinics, Kansas City, MO (Eugenia Pallotto) 16. Arkansas Children's Hospital, Little Rock, AR (Robert Lyle, Becky Rogers) 17. Children's Hospital Los Angeles, Los Angeles, CA (Lisa Kelly,1 1 deceased Steven Chin, Rachel Chapman) 18. American Family Children's Hospital, Madison, WI (Jamie Limjoco, Lori Haack) 19. Children's Hospital & Research Center Oakland, Oakland, CA (David Durand, Jeanette Asselin, Art D'Harlingue, Priscilla Joe) 20. The Children's Hospital of Philadelphia, Philadelphia, PA (Jacquelyn Evans, Michael Padula, David Munson) 21. St. Christopher's Hospital for Children, Philadelphia, PA (Suzanne Touch) 22. Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA (Beverly Brozanski) 23. St. Louis Children's Hospital, St Louis, MO (Tasmin Najaf, Rakesh Rao, Amit Mathur) 24. All Children's Hospital, St. Petersburg, FL (Victor McKay) 25. Rady Children's Hospital, San Diego, CA (Mark Speziale, Brian Lane, Laural Moyer) 26. Children's National Medical Center, Washington, DC (Billie Short) 27. AI DuPont Hospital for Children, Wilmington, DE (Kevin Sullivan) 28. Primary Children's Medical Center, Salt Lake City, UT (Con Yee Ling, Shrena Patel) 29. Children's Hospital of Wisconsin, Milwaukee, WI (Michael Uhing, Ankur Datta) 30. Children's Hospital of Omaha (Lynne Willett, Nicole Birge) 31. Florida Hospital for Children (Rajan Wadhawan) 32. Seattle Children's Hospital, Seattle, WA (Elizabeth Jacobsen-Misbe, Robert DiGeronimo, Zeenia Billimoria) 33. Hospital for Sick Children, Toronto, ON (Kyong-Soon Lee) 34. Children's Hospital Orange County, Los Angeles, CA (Michel Mikhael, Irfan Ahmad)
Keywords
- Extremely low birth weight
- Length of stay
- Morbidity
- Mortality
- Necrotizing enterocolitis
- Short bowel syndrome
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Surgery