Necrotizing enterocolitis: the impact of the establishment of a Department of Pediatric Surgery on the Beilinson Medical Campus.
Necrotizing enterocolitis (NEC) is the most commonly acquired gastrointestinal emergency in neonates. We retrospectively surveyed all cases of confirmed NEC treated at the Beilinson Medical Center (BMC) (now Rabin Medical Center, Beilinson Campus) during a 12 year period to determine whether the establishment of a department of pediatric surgery has influenced the treatment and outcome of NEC patients. Of the 48 patients, 23 were patients treated in the "early period", 1982-87, when surgery was performed in the Department of General Surgery by staff trained in pediatric surgery (group I), and 25 were treated in the "later period" 1988-93, in the same neonatal intensive care unit, with surgical supervision by the new Department of Pediatric Surgery (group II). We found that 32% of the group II patients were of extremely low birthweight (<1,000 g) compared with 13% of group I. They also had lower Apgar scores, and a higher percentage needed respiratory assistance (56 vs. 26%, P = 0.02). All those infants of group II who had been born in other hospitals and were transferred to BMC for treatment were in an advanced state of disease and all required surgery. Total mortality decreased from 22% in group I to 8% in group II. This decrease may be attributed to improved supportive treatment in the neonatal intensive care unit, earlier surgery for NEC based on relative rather than absolute indications, higher rates of primary resection, and better postoperative care. Our review indicates that the establishment of a Department of Pediatric Surgery at the BMC has contributed to the considerable improvement in NEC outcome in our center.
Farkash
U
U
Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petah Tikva.
Freud
E
E
Merlov
P
P
Davidson
S
S
Wilonsky
E
E
Zer
M
M
D000046:Academic Medical Centers; D004761:Enterocolitis, Pseudomembranous / Q000401:mortality / Q000601:surgery*; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007557:Israel / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer; D010372:Pediatrics / Q000458:organization & administration*; D011379:Prognosis; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000458:organization & administration*