title: Clinical importance of a fixed bowel loop in the treatment of necrotizing enterocolitis.
abstract: BACKGROUND
  The need for surgical treatment in neonates with necrotizing enterocolitis (NEC) is associated with high mortality. Although pneumoperitoneum and progressive disease are generally accepted indications for surgery, it is unclear whether a fixed bowel loop (FBL) should prompt surgery.
  
  
  OBJECTIVE
  To determine the relationship between an FBL, type of treatment, and death in the management of NEC.
  
  
  METHODS
  Retrospective analysis (January 2000-December 2011) of all neonates with definite NEC in a tertiary neonatal intensive care unit. FBL was defined as a persistent (i.e. >24 h) dilated intestinal segment present on serial abdominal X-rays.
  
  
  RESULTS
  NEC was diagnosed in 141 neonates (median gestational age 30 weeks; median birth weight 1,340 g). An FBL was reported in 38 (27%) patients, of whom 18 were treated surgically. Mortality among FBL patients was independent of the type of treatment (surgical versus conservative): 8/18 and 7/20, respectively (p = 0.55). Of the 103 patients without FBL, 37 (36%) were treated surgically, which is comparable to the FBL group. Again, mortality was not related to the type of treatment (surgical versus conservative): 5/37 and 6/66, respectively (p = 0.49). The presence of an FBL was associated with mortality: more patients with an FBL (15/38, 39%) died than without an FBL (11/103, 11%; odds ratio 5.45, 95% confidence interval 2.21-13.45; p < 0.01).
  
  
  CONCLUSIONS
  In NEC patients, an FBL is associated with increased mortality. On its own it has moderate significance to guide treatment. Nevertheless, because it reflects disease severity, early recognition is important and prompt (surgical) treatment should be considered.
authors.affiliation: Department of Pediatric Surgery, Beatrix Children's Hospital, University of Groningen, The Netherlands.
authors.forename: Anoek
authors.initials: A
authors.lastname: Muller
authors.forename: Maarten
authors.initials: M
authors.lastname: Schurink
authors.forename: Arend F
authors.initials: AF
authors.lastname: Bos
authors.forename: Christian V
authors.initials: CV
authors.lastname: Hulzebos
authors.forename: Albert
authors.initials: A
authors.lastname: Martijn
authors.forename: Jan B F
authors.initials: JB
authors.lastname: Hulscher
authors.forename: Elisabeth M W
authors.initials: EM
authors.lastname: Kooi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures; D020345:Enterocolitis, Necrotizing / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007422:Intestines / Q000002:abnormalities*; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents