Abstract
Background
Infants with advanced necrotizing enterocolitis (NEC) often need surgical resection of necrotic bowel. We hypothesized that incomplete resection of NEC lesions, signified by the detection of necrotic patches in margins of resected bowel loops, results in inferior clinical outcomes.
Methods
We reviewed the medical records of infants with surgical NEC in the past 15 years for demographic, clinical, and histopathological data. We also developed statistical models to predict mortality and hospital stay.
Results
Ninety infants with surgical NEC had a mean (±standard error) gestational age of 27.3 ± 0.4 weeks, birth weight 1008 ± 48 g, NEC onset at 25.2 ± 2.4 days, and resected bowel length of 29.2 ± 3.2 cm. Seventeen (18.9%) infants who had complete resection of the necrosed bowel had fewer (4; 23.5%) deaths and shorter lengths of hospital stay. In contrast, a group of 73 infants with some necrosis within the margins of resected bowel had significantly more (34; 46.6%) deaths and longer hospital stay. The combination of clinical and histopathological data gave better regression models for mortality and hospital stay.
Conclusion
In surgical NEC, incomplete resection of necrotic bowel increased mortality and the duration of hospitalization. Regression models combining clinical and histopathological data were more accurate for mortality and the length of hospital stay.
Impact
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In infants with surgical NEC, complete resection of necrotic bowel reduced mortality and hospital stay.
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Regression models combining clinical and histopathological information were superior at predicting mortality and hospital stay than simpler models focusing on either of these two sets of data alone.
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Prediction of mortality improved with the combination of antenatal steroids, chorioamnionitis, and duration of post-operative ileus, with severity of inflammation and hemorrhages in resected intestine.
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Length of hospital stay was shorter in infants with higher gestational ages, but longer in those with greater depth of necrosis or needing prolonged parenteral nutrition or supervised feedings.
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Acknowledgements
We thank Dr. Neelesh Tipnis for helping us in developing and reviewing the manuscript. This research was funded by National Institutes of Health awards HL124078 and HL133022 (to A.M.).
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P.M.G., A.M., and A.G.S. designed the study. P.M.G., A.B., M.M.H., A.K., C.B., and A.G.S. collected and analyzed the data. All the authors contributed to and approved the manuscript.
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Garg, P.M., Bernieh, A., Hitt, M.M. et al. Incomplete resection of necrotic bowel may increase mortality in infants with necrotizing enterocolitis. Pediatr Res 89, 163–170 (2021). https://doi.org/10.1038/s41390-020-0975-6
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DOI: https://doi.org/10.1038/s41390-020-0975-6
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