Short-term outcomes for preterm infants with surgical necrotizing enterocolitis

K. Murthy*, T. D. Yanowitz, R. Digeronimo, F. D. Dykes, I. Zaniletti, J. Sharma, K. M. Sullivan, J. Mirpuri, J. R. Evans, R. Wadhawan, A. Piazza, I. Adams-Chapman, J. M. Asselin, B. L. Short, M. A. Padula, D. J. Durand, E. K. Pallotto, K. M. Reber

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Objective:To characterize the population and short-term outcomes in preterm infants with surgical necrotizing enterocolitis (NEC).Study Design:Preterm infants with surgical NEC were identified from 27 hospitals over 3 years using the Children's Hospitals Neonatal Database; infants with gastroschisis, volvulus, major congenital heart disease or surgical NEC that resolved prior to referral were excluded. Patient characteristics and pre-discharge morbidities were stratified by gestational age (<28 vs 28 0/7 to 36 6/7 weeks' gestation).Result:Of the 753 eligible infants, 60% were born at <28 weeks' gestation. The median age at referral was 14 days; only 2 infants were inborn. Male gender (61%) was overrepresented, whereas antenatal steroid exposure was low (46%). Although only 11% had NEC totalis, hospital mortality (<28 weeks' gestation: 41%; 28 0/7 to 36 6/7 weeks' gestation: 32%, P=0.02), short bowel syndrome (SBS)/intestinal failure (IF) (20% vs 26%, P=0.06) and the composite of mortality or SBS/IF (50% vs 49%, P=0.7) were prevalent. Also, white matter injury (11.7% vs 6.6%, P=0.02) and grade 3 to 4 intraventricular hemorrhages (23% vs 2.7%, P<0.01) were commonly diagnosed. After referral, the median length of hospitalization was longer for survivors (106 days; interquartile range (IQR) 79, 152) relative to non-survivors (2 days; IQR 1,17; P<0.001). These survivors were prescribed parenteral nutrition infrequently after hospital discharge (<28 weeks': 5.2%; 28 0/7 to 36 6/7 weeks': 9.9%, P=0.048).Conclusion:After referral for surgical NEC, the short-term outcomes are grave, particularly for infants born <28 weeks' gestation. Although analyses to predict outcomes are urgently needed, these data suggest that affected infants are at a high risk for lengthy hospitalizations and adverse medical and neuro-developmental abnormalities.

Original languageEnglish (US)
Pages (from-to)736-740
Number of pages5
JournalJournal of Perinatology
Volume34
Issue number10
DOIs
StatePublished - Oct 11 2014

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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