Necrotizing enterocolitis: improving survival within a single facility.
Necrotizing enterocolitis (NEC), a disease associated with prematurity, carries a significant morbidity and mortality. This study was designed to evaluate our progress in dealing with NEC both medically and surgically in a single large neonatal intensive care unit (NICU). We also sought to confirm the relation of birth weight and particular indications for operation to outcome. Over 6 1/2 years, there were 7,807 admissions to a large NICU. Though there has been a steady increase in total admissions, especially of infants weighing less than 1,000 gm, survival has improved significantly in all groups (mean 89.1%). NEC occurred in 358 infants (4.6%), and 115 (32%) required surgical intervention. Infants weighing between 751 and 1,000 gm had the highest incidence of NEC. There has been a significant decrease in the mortality of both medically and surgically treated infants with NEC; in both cases, this decrease is weight-dependent. We found that using erythema and edema of the abdominal wall and a fixed-loop roentgenographic pattern as early indicators of necrotic bowel significantly improves survival in surgically treated infants.
Black
T L
TL
Department of Pediatric Surgery, LeBonheur Children's Medical Center, Memphis.
Carr
M G
MG
Korones
S B
SB
D000208:Acute Disease; D001724:Birth Weight; D003131:Combined Modality Therapy; D004630:Emergencies; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D005069:Evaluation Studies as Topic; D006767:Hospitals, District; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D007363:Intensive Care Units, Neonatal; D012189:Retrospective Studies; D013714:Tennessee