title: Low birthweight, gestational age, need for surgical intervention and gram-negative bacteraemia predict intestinal failure following necrotising enterocolitis.
abstract: OBJECTIVE
  Necrotising enterocolitis (NEC) is associated with high morbidity and mortality. The aim of this study was to identify predictors of intestinal failure (IF), morbidity and mortality following NEC.
  
  
  METHODS
  We performed a retrospective study of all neonates treated for NEC stage II or greater at a tertiary referral NICU between 2000 and 2009. Demographic data, need for surgery, residual bowel length and rates of bacteraemia, cholestasis, IF and mortality were analysed.
  
  
  RESULTS
  During the 10-year period, 301 patients were referred with NEC and 152 had surgical intervention. Overall mortality was 32%. Of the 230 infants who survived >42 days, 97 (42%) had IF at 42 days, decreasing to 15% at >90 days. The rate of IF was significantly higher in the surgical group than the medical group (OR 2.04, 95% CI, 1.25-3.35, p < 0.004), but 23% of the medically treated infants with NEC also developed IF. There was a significant relationship between IF and gram-negative bacteraemia, the need for surgery, cholestasis, liver failure and mortality.
  
  
  CONCLUSIONS
  Intestinal failure occurred in a significant proportion of infants with NEC. Predictors for IF among infants with NEC were low birthweight, low gestational age, need for surgical intervention and gram-negative bacteraemia.
authors.affiliation: Divisions of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.|Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Elfvin
authors.affiliation: Divisions of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Elsa
authors.initials: E
authors.lastname: Dinsdale
authors.affiliation: Pediatric Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Wales
authors.affiliation: Divisions of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Aideen M
authors.initials: AM
authors.lastname: Moore
mesh_terms: D016470:Bacteremia / Q000150:complications*; D015331:Cohort Studies; D020345:Enterocolitis, Necrotizing / Q000150:complications* / Q000382:microbiology* / Q000401:mortality / Q000601:surgery; D005865:Gestational Age; D016905:Gram-Negative Bacterial Infections / Q000150:complications*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007422:Intestines; D009102:Multiple Organ Failure / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies
keywords: Gram-negative bacteria; Necrotising enterocolitis; Neonatal gastrointestinal surgery; Short bowel syndrome; Surgical neonates