Surgical necrotizing enterocolitis: are intestinal lesions more severe in infants with low birth weight?
OBJECTIVE
This study examines whether the intestinal lesions of necrotizing enterocolitis (NEC) in infants undergoing surgery are more severe in patients with extremely low birth weight (BW).


METHODS
Between 1980 and 2000, 128 infants underwent laparotomy for NEC: 90 in the acute phase, and 38 for secondary stenosis. Resections were limited to areas of transparietal bowel necrosis and to secondary stenoses. The authors studied the extent of initial bowel lesions at initial laparotomy, and, in the survivors, the extent of bowel resections and the existence of digestive sequelae, with a median follow-up of 24 (range, 1 to 247) months. Children with BW < or =1,000 g (group 1, 22 patients) and greater than 1,000 g (group 2, 103 patients) were compared by using chi(2) and t test.


RESULTS
Patients' survival rate was 87%: 68% and 91% in the groups 1 and 2, respectively (P =.01). No significant difference between the 2 groups was seen: (1) for the rate of patients with panintestinal lesions at initial surgery (12%); (2) in the survivors, the ratio of remaining to total length of jejuno-ileum (mean 88%), the number of colonic segments resected (mean 1.2), the rate of survivors without distal ileum (34%), ileo-caecal valve (39%), or right colon (29%); and (3) for the existence of digestive symptoms, even minor, at last follow-up (25%).


CONCLUSIONS
Although the prognosis of surgical NEC was worse in infants with extremely low birth weight, the intestinal lesions were not found more severe in these patients.
Chardot
Christophe
C
Pediatric Surgery Unit, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin Bicêtre, France.
Rochet
Jean Stephan
JS
Lezeau
Harry
H
Sen
Nuri
N
Brouillard
Vincent
V
Caeymaex
Laurence
L
Verellen
Gaston
G
Otte
Jean Bernard
JB
Gauthier
Frédéric
F
Reding
Raymond
R
D000208:Acute Disease; D020345:Enterocolitis, Necrotizing / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D007422:Intestines / Q000473:pathology* / Q000601:surgery; D009336:Necrosis; D011379:Prognosis; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate