Outcomes of the "clip and drop" technique for multifocal necrotizing enterocolitis.
BACKGROUND
The "clip and drop" (CD) has been proposed as a useful strategy in the management of severe multifocal necrotizing enterocolitis (NEC). There is little published data on clinical outcomes after this intervention. We report a 2-center experience with this technique.


METHODS
A retrospective review of infants who underwent CD between 1998 and 2006 at 2 tertiary pediatric surgery centers. Data recorded included intestinal resections, interval between laparotomies, anastomoses at subsequent surgery, time to full feeds, and complications including mortality. Data are reported as median with ranges.


RESULTS
Thirteen infants (7 male, 6 female) with a birth weight of 811 (514-2110) g underwent CD of up to 5 bowel segments. In 8 of 9 early survivors, all CD segments were viable. Six patients (46%) were alive at 29 (9-96) months. Survivors underwent 4 (3-4) laparotomies and 4 (2-6) bowel anastomoses and had intestinal continuity restored at 67 (51-162) days.


CONCLUSIONS
With multiple interventions, half the infants in this high-risk group survived and achieved full enteral feeds. The CD is a valuable technique in a selected group of infants with fulminant NEC.
Ron
Ori
O
Department of Pediatric Surgery, King's College Hospital NHS Trust, SE5 9RS London, United Kingdom.
Davenport
Mark
M
Patel
Shailesh
S
Kiely
Edward
E
Pierro
Agostino
A
Hall
Nigel J
NJ
Ade-Ajayi
Niyi
N
D016638:Critical Illness; D013505:Digestive System Surgical Procedures / Q000379:methods* / Q000401:mortality; D020345:Enterocolitis, Necrotizing / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007813:Laparotomy / Q000379:methods; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome