title: International survey on the management of necrotizing enterocolitis.
abstract: OBJECTIVE
  The aim of this study is to define patterns in the management of necrotizing enterocolitis (NEC).
  
  
  METHODS
  A total of 80 delegates (81% senior surgeons) from 29 (20 European) countries completed a survey at the European Pediatric Surgeons' Association 2013 annual meeting.
  
  
  RESULTS
  Overall, 59% surgeons work in centers where>10 cases of NEC are treated per year.
  
  
  METHODS
  76% surgeons request both anteroposterior and lateral abdominal X-rays, which are performed at regular intervals by 66%; 50% surgeons also request Doppler ultrasonography; most frequently used biochemical markers are platelets (99% of surgeons), C-reactive protein (90%), and white cell count (83%). Laparoscopy is performed for diagnosis and/or treatment of NEC by only 8% surgeons. Overall, 43% surgeons reported being able to diagnose focal intestinal perforation preoperatively. Medical NEC: medical NEC is managed by surgical and neonatal teams together in most centers (84%). Most surgeons (67%) use a combination of two (51%) or three (48%) antibiotics for more than 7 days, and keep patients nil by mouth for 7 (41%) or 10 (49%) days. Surgical NEC: In extremely low-birth-weight infants (< 1,000 g) with intestinal perforation, 27% surgeons opt for primary peritoneal drainage (PPD) as definitive treatment. Overall, 67% think that peritoneal drainage is important for stabilization and transport. At laparotomy, treatments vary according to NEC severity. About 75% surgeons always close the abdomen, and 29% leave a patch to prevent compartment syndrome.
  
  
  METHODS
  Infants are kept nil by mouth for 5 to 7 days by 46% surgeons, more than 7 days by 42%, and less than 5 days by 12% surgeons. Most surgeons (77%) restart infants on breast milk, 11.5% on aminoacid-based formulas, and 11.5% on hydrolyzed formulas. Most surgeons (92%) follow-up NEC patients after discharge, up to 5 years of life (56%) and 65% surgeons organize a neurodevelopmental follow-up.
  
  
  CONCLUSIONS
  Many aspects of NEC management are lacking consensus and surgeons differ especially over surgical treatment of complex cases and postoperative management. Prospective multi-center studies are needed to guide an evidence-based management of NEC.
authors.affiliation: Department of Pediatric Surgery, Sapienza University of Rome, Rome, Italy.
authors.forename: Augusto
authors.initials: A
authors.lastname: Zani
authors.affiliation: Department of Paediatric Surgery, University College London, Institute of Child Health, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Eaton
authors.affiliation: Department of Pediatric Surgery, National Children's Research Centre, Dublin, Ireland.
authors.forename: Prem
authors.initials: P
authors.lastname: Puri
authors.affiliation: Department of Paediatric Surgery, Hospital for Children and Adolescents, Helsinki, Finland.
authors.forename: Risto
authors.initials: R
authors.lastname: Rintala
authors.affiliation: Department of Pediatric Surgery, Faculty of Medicine, University Children's Hospital, Belgrade, Serbia.
authors.forename: Marija
authors.initials: M
authors.lastname: Lukac
authors.affiliation: Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Bagolan
authors.affiliation: Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Joachim F
authors.initials: JF
authors.lastname: Kuebler
authors.affiliation: Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Hoellwarth
authors.affiliation: Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen,The Netherlands.
authors.forename: Rene
authors.initials: R
authors.lastname: Wijnen
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Tovar
authors.affiliation: Department of Paediatric Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Agostino
authors.initials: A
authors.lastname: Pierro
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004322:Drainage / Q000706:statistics & numerical data; D004334:Drug Administration Schedule; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005060:Europe; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D007813:Laparotomy / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents