Multisystem organ failure and capillary leak syndrome in severe necrotizing enterocolitis of very low birth weight infants.
BACKGROUND
Classification systems for necrotizing enterocolitis (NEC) in preterm infants have been developed to define severity grades relevant for treatment and prognosis. Multisystem organ failure (MSOF) and capillary leak syndrome (CLS) also have prognostic value in these patients. The aim of this retrospective study was to investigate the incidence and predictive value of MSOF and CLS according to the classification criteria.


METHODS
The records of 1,022 very low birth weight infants admitted from 1982 to 1996 were reviewed for diagnosis of NEC stage IIA or higher (classification of Walsh and Kliegman). Among those patients (n = 50) the incidence of MSOF and CLS was determined, separately for surgical or conservative treatment.


RESULTS
Twelve patients were assigned to stage II, 22 to stage IIIa, and 16 to stage IIIb; 31 infants underwent operation. Mortality rate was not influenced by the grade. In eight patients only gastrointestinal symptoms were found, whereas in 23 patients, up to three organ systems and in 19 patients, four or more organ systems were affected. Mortality depended on the number of involved organ systems. CLS occurred postoperatively in 10 of the 31 infants; eight of them died.


CONCLUSIONS
The prognostic values of MSOF and CLS are higher than that of classification criteria in NEC of VLBW infants.
Sonntag
J
J
Department of Neonatology, Clinic of Pediatric Surgery, Charité-Virchow-Klinikum, Humboldt University, Berlin, Germany.
Wagner
M H
MH
Waldschmidt
J
J
Wit
J
J
Obladen
M
M
D019559:Capillary Leak Syndrome / Q000175:diagnosis / Q000209:etiology*; D004761:Enterocolitis, Pseudomembranous / Q000145:classification / Q000150:complications* / Q000401:mortality; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000145:classification / Q000401:mortality; D019102:Infant, Very Low Birth Weight; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies