title: Short-term outcomes for preterm infants with surgical necrotizing enterocolitis.
abstract: OBJECTIVE
  To characterize the population and short-term outcomes in preterm infants with surgical necrotizing enterocolitis (NEC).
  
  
  METHODS
  Preterm infants with surgical NEC were identified from 27 hospitals over 3 years using the Children's Hospitals Neonatal Database; infants with gastroschisis, volvulus, major congenital heart disease or surgical NEC that resolved prior to referral were excluded. Patient characteristics and pre-discharge morbidities were stratified by gestational age (<28 vs 28(0/7) to 36(6/7) weeks' gestation).
  
  
  RESULTS
  Of the 753 eligible infants, 60% were born at <28 weeks' gestation. The median age at referral was 14 days; only 2 infants were inborn. Male gender (61%) was overrepresented, whereas antenatal steroid exposure was low (46%). Although only 11% had NEC totalis, hospital mortality (<28 weeks' gestation: 41%; 28(0/7) to 36(6/7) weeks' gestation: 32%, P=0.02), short bowel syndrome (SBS)/intestinal failure (IF) (20% vs 26%, P=0.06) and the composite of mortality or SBS/IF (50% vs 49%, P=0.7) were prevalent. Also, white matter injury (11.7% vs 6.6%, P=0.02) and grade 3 to 4 intraventricular hemorrhages (23% vs 2.7%, P<0.01) were commonly diagnosed. After referral, the median length of hospitalization was longer for survivors (106 days; interquartile range (IQR) 79, 152) relative to non-survivors (2 days; IQR 1,17; P<0.001). These survivors were prescribed parenteral nutrition infrequently after hospital discharge (<28 weeks': 5.2%; 28(0/7) to 36(6/7) weeks': 9.9%, P=0.048).
  
  
  CONCLUSIONS
  After referral for surgical NEC, the short-term outcomes are grave, particularly for infants born <28 weeks' gestation. Although analyses to predict outcomes are urgently needed, these data suggest that affected infants are at a high risk for lengthy hospitalizations and adverse medical and neuro-developmental abnormalities.
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University Chicago, Chicago, IL, USA.
authors.forename: K
authors.initials: K
authors.lastname: Murthy
authors.affiliation: Children's Hospital of Pittsburgh and the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: T D
authors.initials: TD
authors.lastname: Yanowitz
authors.affiliation: Department of Pediatrics, University of Utah and the Primary Childreńs Medical Center, Salt Lake City, UT, USA.
authors.forename: R
authors.initials: R
authors.lastname: DiGeronimo
authors.affiliation: Children's Healthcare of Atlanta at Egleston and the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: F D
authors.initials: FD
authors.lastname: Dykes
authors.affiliation: Children's Hospital Association, Inc., Overland Park, KS, USA.
authors.forename: I
authors.initials: I
authors.lastname: Zaniletti
authors.affiliation: Children's Mercy Hospitals & Clinics, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.
authors.forename: J
authors.initials: J
authors.lastname: Sharma
authors.affiliation: 1] Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA [2] Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Sullivan
authors.affiliation: Children's Medical Center and the Department of Pediatrics, University of Texas-Southwestern Medical Center, Dallas, TX, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mirpuri
authors.affiliation: Children's Hospital of Philadelphia and the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Evans
authors.affiliation: Department of Pediatrics, University of South Florida and the Florida Hospital for Children, Orlando, FL, USA.
authors.forename: R
authors.initials: R
authors.lastname: Wadhawan
authors.affiliation: Children's Healthcare of Atlanta at Egleston and the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Piazza
authors.affiliation: Children's Healthcare of Atlanta at Egleston and the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: I
authors.initials: I
authors.lastname: Adams-Chapman
authors.affiliation: Department of Pediatrics, Children's Hospital Oakland & Research Center, Neonatal/Pediatric Research, Oakland, CA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Asselin
authors.affiliation: Children's National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
authors.forename: B L
authors.initials: BL
authors.lastname: Short
authors.affiliation: Children's Hospital of Philadelphia and the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Padula
authors.affiliation: Department of Pediatrics, Children's Hospital Oakland & Research Center, Oakland, CA, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Durand
authors.affiliation: Children's Mercy Hospitals & Clinics, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.
authors.forename: E K
authors.initials: EK
authors.lastname: Pallotto
authors.affiliation: Nationwide Children's Hospital and the Department of Pediatrics at The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Reber
mesh_terms: D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000401:mortality; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States