Long-term follow-up after bowel resection for necrotizing enterocolitis: factors affecting outcome.
BACKGROUND
Necrotizing enterocolitis (NEC) is the most common surgical emergency among newborns and is associated with a high morbidity and mortality. This study evaluates the long-term survival of infants requiring surgical intervention for NEC and factors affecting outcome.


METHODS
A retrospective review of infants requiring surgery for complications of NEC at a tertiary care, pediatric hospital over a 16-year period was performed. Patients were evaluated for early and late morbidity and mortality, length of intestinal resection, presence of the ileocecal valve (ICV), days of parenteral nutrition (PN), and growth.


RESULTS
Two hundred forty-nine patients were included, with an average gestational age of 30 +/- 5 (+/- SD) weeks and birth weight of 1.50 +/- 0.89 kg. The surgical mortality rate was 45%, with survivors (137) being larger (P < .001) and older (P < .001) at time of birth than nonsurvivors. Mortality rates varied inversely with gestational age and birth weight. Surgical survivors had an average of 21 +/- 26 cm of intestinal length resected. The ileocecal valve was preserved in 45% of infants. Growth was similar between infants with or without an ICV. Stratification of length of intestine resected showed that infants with larger resections had greater requirements for parenteral nutrition, but this had no influence on long-term growth at follow-up.


CONCLUSIONS
Survivors of NEC are characterized by greater gestational age, greater birth weight, and older postgestational age at surgery. Infants who underwent greater intestinal resections required longer periods of PN. The length of intestine resected or presence of the ileocecal valve had no overall bearing on long-term outcome.
Department of Surgery, Indiana University School of Medicine and the James Whitcomb Riley Hospital for Children, Indianapolis 46202-5200, USA.
A P
AP
Ladd
F J
FJ
Rescorla
K W
KW
West
L R
LR
Scherer
S A
SA
Engum
J L
JL
Grosfeld
D000367:Age Factors; D001724:Birth Weight; D002423:Cause of Death; D016009:Chi-Square Distribution; D004761:Enterocolitis, Pseudomembranous / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007902:Length of Stay; D008297:Male; D018529:Nutritional Support; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis