The outcome of critically ill neonates undergoing laparotomy for necrotising enterocolitis in the neonatal intensive care unit: a 10-year review

• Published in: Journal of pediatric surgery Vol. 49; no. 8; pp. 1210 - 1214
• Main Authors: Wright, Naomi J, Thyoka, Mandela, Kiely, Edward M, Pierro, Agostino, De Coppi, Paolo, Cross, Kate M.K, Drake, David D, Peters, Mark J, Curry, Joe I
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2014
• Subjects: Critical Illness; Enterocolitis, Necrotizing - surgery; Female; Follow-Up Studies; Forecasting; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Laparotomy; Laparotomy - methods; Male; Necrotising enterocolitis (NEC); Neonatal intensive care unit (NICU); Outcome; Pediatrics; Postoperative Complications - epidemiology; Retrospective Studies; Surgery; Treatment Outcome; United Kingdom - epidemiology; Necrotising enterocolitis (NEC); Laparotomy; Neonatal intensive care unit (NICU); Outcome
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2014.01.052

Abstract Purpose To evaluate outcomes in critically ill neonates with necrotising enterocolitis (NEC) undergoing a laparotomy in the neonatal intensive care unit (NICU). Methods This is a retrospective review of neonates diagnosed with NEC who underwent a laparotomy on NICU between 2001 and 2011. Demographic, diagnostic, operative and outcome data were analysed. Nonparametric comparison was used. Data are reported as median (range). Results 221 infants with NEC were referred for surgical evaluation; 182 (82%) underwent surgery; 15 (8%) required a laparotomy on NICU. Five had NEC totalis, 4 multifocal disease and 6 focal disease. Five had an open and close laparotomy, 8 stoma with/without bowel resection and 2 bowel resection and primary anastomosis. Ten (67%) died at a median of 6.5-hours (2–72) postoperatively; 2 died at 72 and 264-days. The 30-day mortality rate was higher (p = 0.01) among infants undergoing a laparotomy on NICU (10/15; 67%) than in theatre (54/167; 32%). There was no significant difference in mean Paediatric Index of Mortality 2 Scores between survivors and nonsurvivors (p = 0.55). Three (20%) infants remain alive with no or minimal disability at 1.4 (0.5–7.5) years. Conclusion Laparotomy for NEC on NICU is a treatment option for neonates who are too unstable to transfer to theatre. However, with 67% dying within 6.5-hours and a further 13% after months in hospital, we must consider whether surgery is always in their best interests. Development of a prediction model to help distinguish those at highest risk of long-term morbidity and mortality could help with decision making in this difficult situation.