title: The outcome of critically ill neonates undergoing laparotomy for necrotising enterocolitis in the neonatal intensive care unit: a 10-year review.
abstract: OBJECTIVE
  To evaluate outcomes in critically ill neonates with necrotising enterocolitis (NEC) undergoing a laparotomy in the neonatal intensive care unit (NICU).
  
  
  METHODS
  This is a retrospective review of neonates diagnosed with NEC who underwent a laparotomy on NICU between 2001 and 2011. Demographic, diagnostic, operative and outcome data were analysed. Nonparametric comparison was used. Data are reported as median (range).
  
  
  RESULTS
  221 infants with NEC were referred for surgical evaluation; 182 (82%) underwent surgery; 15 (8%) required a laparotomy on NICU. Five had NEC totalis, 4 multifocal disease and 6 focal disease. Five had an open and close laparotomy, 8 stoma with/without bowel resection and 2 bowel resection and primary anastomosis. Ten (67%) died at a median of 6.5-hours (2-72) postoperatively; 2 died at 72 and 264-days. The 30-day mortality rate was higher (p=0.01) among infants undergoing a laparotomy on NICU (10/15; 67%) than in theatre (54/167; 32%). There was no significant difference in mean Paediatric Index of Mortality 2 Scores between survivors and nonsurvivors (p=0.55). Three (20%) infants remain alive with no or minimal disability at 1.4 (0.5-7.5) years.
  
  
  CONCLUSIONS
  Laparotomy for NEC on NICU is a treatment option for neonates who are too unstable to transfer to theatre. However, with 67% dying within 6.5-hours and a further 13% after months in hospital, we must consider whether surgery is always in their best interests. Development of a prediction model to help distinguish those at highest risk of long-term morbidity and mortality could help with decision making in this difficult situation.
authors.affiliation: Paediatric Surgery Department, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Naomi J
authors.initials: NJ
authors.lastname: Wright
authors.affiliation: Paediatric Surgery Department, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Mandela
authors.initials: M
authors.lastname: Thyoka
authors.affiliation: Paediatric Surgery Department, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Kiely
authors.affiliation: Paediatric Surgery Department, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Agostino
authors.initials: A
authors.lastname: Pierro
authors.affiliation: Paediatric Surgery Department, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Paolo
authors.initials: P
authors.lastname: De Coppi
authors.affiliation: Paediatric Surgery Department, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Kate M K
authors.initials: KM
authors.lastname: Cross
authors.affiliation: Paediatric Surgery Department, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: David D
authors.initials: DD
authors.lastname: Drake
authors.affiliation: Paediatric Surgery Department, Great Ormond Street Hospital for Children, London, United Kingdom.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Peters
authors.affiliation: Paediatric Surgery Department, Great Ormond Street Hospital for Children, London, United Kingdom. Electronic address: Joe.Curry@gosh.nhs.uk.
authors.forename: Joe I
authors.initials: JI
authors.lastname: Curry
mesh_terms: D016638:Critical Illness; D020345:Enterocolitis, Necrotizing / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007813:Laparotomy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Laparotomy; Necrotising enterocolitis (NEC); Neonatal intensive care unit (NICU); Outcome