Surgical necrotizing enterocolitis: A primer for the neonatologist

Necrotizing enterocolitis (NEC) is the most common surgical emergency among NICU patients. Patients with NEC requiring surgical intervention have the highest morbidity and mortality and accrue the highest costs. The objective of this review is to provide the neonatologist with an overview of options available for the surgical management of this complex and potentially devastating disease. When evaluating patients with NEC, surgical intervention is reserved for those patients with pneumoperitoneum, confirmed stool or pus in the peritoneal cavity, or worsening clinical status. Options range from peritoneal drain placement to laparotomy with enterostomy creation, anastomoses, or temporizing measures with planned second-look operations. The choice of operation has not been shown to have a significant effect on any clinically important outcomes. The mortality rate for surgically managed NEC remains dependent upon the severity of disease and is directly correlated to gestational age.