Characteristics and outcomes of a multi-institution cohort of infants with necrotizing enterocolitis totalis

• Published in: Journal of perinatology Vol. 42; no. 4; pp. 440 - 445
• Main Authors: Rose, Allison T., Zaniletti, Isabella, Santore, Matthew T., Piazza, Anthony J.
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.04.2022; Nature Publishing Group
• Subjects: 692/1807; 692/699/1503/1581; Child; Cohort Studies; Enterocolitis; Enterocolitis, Necrotizing - surgery; Female; Fetal Diseases; Gastrointestinal diseases; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infants; Intestinal Perforation - surgery; Intestine; Medicine; Medicine & Public Health; Mortality; Necrosis; Necrotizing enterocolitis; Neonates; Pediatric Surgery; Pediatrics; Pregnancy; Retrospective Studies; Surgery
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-021-01191-7

ABSTRACT Objective To characterize the presentation, management and outcomes of infants with necrotizing enterocolitis totalis ( t NEC) vs surgical non-totalis NEC ( s NEC). Study design This retrospective study identified infants undergoing surgery for NEC through The Children’s Hospitals Neonatal Database. Demographic, surgical and mortality characteristics were compared. Results Of 1059 infants, 161 (15.2%) had t NEC. Perinatal characteristics did not differ. t NEC infants were older and were less likely to have pneumoperitoneum at referral (5.6% vs 13.1%, p  < 0.001) or intestinal perforation at surgery (38.5% vs 66.7%, p  < 0.001). Infants with t NEC were more acidotic preoperatively (7.1, [IQR 7, 7.3] vs 7.3, [IQR 7.2, 7.4], p  < 0.001). Mortality was 96.9% for t NEC and 26.5% for s NEC ( p  < 0.001). t NEC cases varied by center, accounting for 0–43% of all surgical NEC cases. Conclusions Mortality is high for t NEC infants, who present at older age, with greater illness severity but are less likely to have intestinal perforation than s NEC infants.