Surgical necrotizing enterocolitis.
Although currently available data are variable, it appears that the incidence of surgical necrotizing enterocolitis (NEC) has not decreased significantly over the past decade. Pneumoperitoneum and clinical deterioration despite maximal medical therapy remain the most common indications for operative treatment. Robust studies linking outcomes with specific indications for operation are lacking. Promising biomarkers for severe NEC include fecal calprotectin and S100A12; serum fatty acid-binding protein; and urine biomarkers. Recent advances in ultrasonography make this imaging modality more useful in identifying surgical NEC and near-infrared spectroscopy (NIRS) is being actively studied. Another fairly recent finding is that regionalization of care for infants with NEC likely improves outcomes. The neurodevelopmental outcomes after surgical treatment are known to be poor. A randomized trial near completion will provide robust data regarding neurodevelopmental outcomes after laparotomy versus drainage as the initial operative treatment for severe NEC.
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.
Jamie R
JR
Robinson
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN.
Eric J
EJ
Rellinger
Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
L Dupree
LD
Hatch
Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
Joern-Hendrik
JH
Weitkamp
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN.
K Elizabeth
KE
Speck
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN.
Melissa
M
Danko
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: Martin.blakely@vanderbilt.edu.
Martin L
ML
Blakely
D015415:Biomarkers / Q000378:metabolism; D004322:Drainage; D020345:Enterocolitis, Necrotizing / Q000503:physiopathology / Q000601:surgery*; D004766:Enterostomy; D050556:Fatty Acid-Binding Proteins / Q000378:metabolism; D005243:Feces; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000503:physiopathology / Q000601:surgery*; D019102:Infant, Very Low Birth Weight; D007813:Laparotomy; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism; D018579:Patient Selection; D011237:Predictive Value of Tests; D000067616:S100A12 Protein / Q000378:metabolism; D016896:Treatment Outcome
D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D039841:Leukocyte L1 Antigen Complex; D000067616:S100A12 Protein; C090441:S100A12 protein, human
Surgical NEC; Surgical necrotizing enterocolitis