Multicenter retrospective study on management and outcome of newborns affected by surgical necrotizing enterocolitis.
BACKGROUND
Necrotizing enterocolitis (NEC) is the most common surgical emergency in newborns and it is still a leading cause of death despite the improvements reached in the management of the critically ill neonate. The purpose of this study was to evaluate risk factors, surgical treatments and outcome of surgical NEC.


METHODS
We retrospectively evaluated a multicentric group of 184 patients with surgical NEC over a period of 5 years (2008-2012). Indications to operation were modified NEC Bell stages IIIA or IIIB. The main outcome was measured in terms of survival and postsurgical complications.


RESULTS
Data on 184 patients who had a surgical NEC were collected. The majority of patients (153) had a primary laparotomy (83%); 10 patients had peritoneal drainage insertion alone (5%) and 21 patients had peritoneal drainage followed by laparotomy (12%). Overall mortality was 28%. Patients with lower gestational age (P=0.001), lower birth weight (P=0.001), more extensive intestinal involvement (P=0.002) and cardiac diseases (P=0.012) had a significantly higher incidence of mortality. There was no statistically significant association between free abdominal air on the X-ray and mortality (P=0.407). Mortality in the drainage group was 60%, in the laparotomy group and drainage followed by laparotomy group was of 23-24% (P=0.043). There was a high incidence of stenosis (28%) in the drainage group (P=0.002). On multivariable regression, lower birth weight, feeding, bradycardia-desaturation and extent of bowel involvement were independent predictors of mortality.


CONCLUSIONS
Laparotomy was the most frequent method of treatment (83%). Primary laparotomy and drainage with laparotomy groups had similar mortalities (23-24%), while the drainage alone treatment cohort was associated with the highest mortality (60%) with statistical value (P=0.043). Consequently laparotomy is highly protective in terms of survival rate. Stenosis seemed to be statistically associated with drainage. These findings could discourage the use of peritoneal drainage versus a primary laparotomy whenever the clinical conditions of patients allow this procedure.
Pediatric Surgery Unit, Infermi Hospital, Rimini, Italy.
Silvana
S
Federici
Pediatric Surgery Unit, Infermi Hospital, Rimini, Italy - ldeb76@libero.it.
Lorenzo
L
DE Biagi
Pediatric Surgery Unit, Infermi Hospital, Rimini, Italy.
Simona
S
Straziuso
Pediatric Surgery Department, IRCCS Ca' Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy.
Ernesto
E
Leva
Pediatric Surgery Department, IRCCS Ca' Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy.
Giulia
G
Brisighelli
Pediatric Surgery Unit, Giannina Gaslini Institute, Genoa, Italy.
Girolamo
G
Mattioli
Pediatric Surgery Unit, Giannina Gaslini Institute, Genoa, Italy.
Luca
L
Pio
Medical and Surgical Neonatology Department, Bambin Gesù Children's Hospital, Rome, Italy.
Pietro
P
Bagolan
Medical and Surgical Neonatology Department, Bambin Gesù Children's Hospital, Rome, Italy.
Giorgia
G
Totonelli
Neonatal Surgery Unit, Meyer University Children's Hospital, Florence, Italy.
Bruno
B
Noccioli
Neonatal Surgery Unit, Meyer University Children's Hospital, Florence, Italy.
Elisa
E
Severi
Pediatric Surgery Department, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy.|Pediatric Surgery Unit, Spirito Santo Hospital, Pescara, Italy.
Pierluigi
P
Lelli Chiesa
Pediatric Surgery Department, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy.|Pediatric Surgery Unit, Spirito Santo Hospital, Pescara, Italy.
Gabriele
G
Lisi
Neonatal Surgical Unit, Santobono Children's Hospital, Naples, Italy.
Antonino
A
Tramontano
Neonatal Surgical Unit, Santobono Children's Hospital, Naples, Italy.
Carolina
C
DE Chiara
Pediatric Surgery Unit, Maggiore University Hospital of Parma, Parma, Italy.
Carmine
C
Del Rossi
Pediatric Surgery Unit, Maggiore University Hospital of Parma, Parma, Italy.
Giovanni
G
Casadio
Pediatric Surgery Unit, Department of Medical Sciences, Surgery, and Neuroscience, University of Siena, Siena, Italy.
Mario
M
Messina
Pediatric Surgery Unit, Department of Medical Sciences, Surgery, and Neuroscience, University of Siena, Siena, Italy.
Rossella
R
Angotti
Pediatric Surgery Unit, University of Perugia, Perugia, Italy.
Antonino
A
Appignani
Pediatric Surgery Unit, University of Perugia, Perugia, Italy.
Mirko
M
Bertozzi
Pediatric Surgery Department, Ospedale Maggiore della Carità, Novara, Italy.
Fabio
F
Rossi
Pediatric Surgery Department, Ospedale Maggiore della Carità, Novara, Italy.
Valeria
V
Gabriele
Pediatric Surgery Department, Sant'Anna Hospital, Cona, Ferrara, Italy.
Andrea
A
Franchella
Pediatric Surgery Department, Sant'Anna Hospital, Cona, Ferrara, Italy.
Veronica
V
Zocca
D001724:Birth Weight; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013396:Suction / Q000379:methods; D015996:Survival Rate