Does the Timing of Surgical Intervention Impact Outcomes in Necrotizing Enterocolitis?

被引:0
作者
Rauh, Jessica L. [1 ]
Reddy, Menaka N. [1 ]
Santella, Nicole L. [1 ]
Ellison, Maryssa A. [2 ]
Weis, Victoria G. [2 ]
Zeller, Kristen A. [3 ]
Garg, Parvesh M. [4 ]
Ladd, Mitchell R. [2 ,3 ]
机构
[1] Wake Forest Sch Med, Gen Surg, 1 Med Ctr Blvd, Winston Salem, NC 27157 USA
[2] Wake Forest Inst Regenerat Med, Winston Salem, NC USA
[3] Wake Forest Sch Med, Dept Pediat Surg, Gen Surg, Winston Salem, NC USA
[4] Wake Forest Sch Med, Neonatol, Winston Salem, NC USA
关键词
pediatric surgery; gastrointestinal; INFANTS;
D O I
10.1177/00031348241256054
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objectives: The optimal time for intervention in surgical necrotizing enterocolitis (sNEC) remains to be elucidated. Surgical management varies between peritoneal drain (PD), laparotomy (LAP), and PD with subsequent LAP (PD + LAP). We propose that some infants with surgical NEC benefit from late (>48 h) operative intervention to allow for resuscitation. Methods: A retrospective comparison of clinical information in infants with sNEC from 2012 to 2022 was performed. Early intervention was defined as less than 48 hours from time of NEC diagnosis to surgical intervention. Results: 118 infants were identified, 92 underwent early intervention (62 LAP; 22 PD; 8 PD + LAP) and 26 underwent late intervention (20 LAP; 2 PD; 4 PD + LAP). Infants with early intervention were diagnosed younger (DOL 8 [6, 15] vs 20 [11, 26]; P=< .05) with more pneumoperitoneum (76% vs 23%; P=< .05). The early intervention group had a higher mortality (35% vs 15%; P=< .05). When excluding infants with pneumoperitoneum, the early intervention group had a higher mortality rate (10/22 (45%), 4/26 (15%); P < .05) and had more bowel resected (29 +/- 17 cm vs 9 +/- 8 cm; P < .05), with the same number of patients scoring above 3 on the MD7 criteria. Conclusion: Infants with NEC who underwent early surgical intervention had a higher mortality and more bowel resected. While this study has a provocative finding, it is severely limited by the non-specific 48-hour cut off. However, our data suggests that a period of medical optimization may improve outcomes in infants with sNEC and thus more in-depth studies are needed.
引用
收藏
页码:2279 / 2284
页数:6
相关论文
共 50 条
[41]   Correlation of systemic immune-inflammation Index with surgical necrotizing enterocolitis [J].
Feng, Wei ;
Hou, Jinping ;
Xiang, Chenzhu ;
Die, Xiaohong ;
Sun, Jing ;
Guo, Zhenhua ;
Liu, Wei ;
Wang, Yi .
FRONTIERS IN PEDIATRICS, 2022, 10
[42]   Antibiotics in the medical and surgical treatment of necrotizing enterocolitis. A systematic review [J].
Gill, Ester Maria ;
Jung, Kristine ;
Qvist, Niels ;
Elleb, Mark Bremholm .
BMC PEDIATRICS, 2022, 22 (01)
[43]   The impact of maternal stress on the development of necrotizing enterocolitis: A comprehensive review [J].
Cheddadi, Riadh ;
Khandekar, Nitika Narendra ;
Yeramilli, Venkata ;
Martin, Colin .
SEMINARS IN PEDIATRIC SURGERY, 2023, 32 (03)
[44]   The fifty billion dollar question: does formula cause necrotizing enterocolitis? [J].
Underwood, Mark A. .
JOURNAL OF PERINATOLOGY, 2025, 45 (05) :565-571
[45]   Intestinal failure associated cholestasis in surgical necrotizing enterocolitis and spontaneous intestinal perforation [J].
Karila, Kristiina ;
Anttila, Annaleena ;
Iber, Tarja ;
Pakarinen, Mikko ;
Koivusalo, Antti .
JOURNAL OF PEDIATRIC SURGERY, 2019, 54 (03) :460-464
[46]   Cholestasis is associated with a higher rate of complications in both medical and surgical necrotizing enterocolitis [J].
Nayak, Sujir Pritha ;
Huff, Katie A. ;
Zaniletti, Isabella ;
Ahmad, Irfan ;
DiGeronimo, Robert ;
Hair, Amy ;
Kim, Jae ;
Markel, Troy A. ;
Piazza, Anthony ;
Reber, Kristina ;
Roberts, Jessica ;
Sharma, Jotishna ;
Sullivan, Kevin ;
Premkumar, Muralidhar H. ;
Yanowitz, Toby .
JOURNAL OF PERINATOLOGY, 2024, 44 (01) :100-107
[47]   Quality Improvement Efforts Reduce Incidence of Surgical Necrotizing Enterocolitis and Related Deaths [J].
Goddard, Gillian R. ;
McNelis, Kera ;
Poindexter, Anne ;
Jenkins, Todd ;
Wessel, Jacqueline ;
Nathan, Amy T. ;
Helmrath, Michael A. ;
Poindexter, Brenda .
AMERICAN JOURNAL OF PERINATOLOGY, 2021, 38 (13) :1386-1392
[48]   Multicenter retrospective study on management and outcome of newborns affected by surgical necrotizing enterocolitis [J].
Federici, Silvana ;
De Biagi, Lorenzo ;
Straziuso, Simona ;
Leva, Ernesto ;
Brisighelli, Giulia ;
Mattioli, Girolamo ;
Pio, Luca ;
Bagolan, Pietro ;
Totonelli, Giorgia ;
Noccioli, Bruno ;
Severi, Elisa ;
Lelli Chiesa, Pierluigi ;
Lisi, Gabriele ;
Tramontano, Antonino ;
De Chiara, Carolina ;
Del Rossi, Carmine ;
Casadio, Giovanni ;
Messina, Mario ;
Angotti, Rossella ;
Appignani, Antonino ;
Bertozzi, Mirko ;
Rossi, Fabio ;
Gabriele, Valeria ;
Franchella, Andrea ;
Zocca, Veronica .
MINERVA CHIRURGICA, 2017, 72 (03) :183-187
[49]   Asymptomatic Congenital Lung Malformations: Timing of Resection Does Not Affect Adverse Surgical Outcomes [J].
Duron, Vincent ;
Zenilman, Ariela ;
Griggs, Cornelia ;
DeFazio, Jennifer ;
Price, Jessica C. ;
Fan, Weijia ;
Vivero, Matthew ;
Castrillon, Juliana ;
Schmaedick, Maggie ;
Iqbal, Emaad ;
Rothenberg, Steven .
FRONTIERS IN PEDIATRICS, 2020, 8
[50]   Impact of Surgical Timing on Outcomes in Neonatal Inguinal Hernia Repairs: A Systematic Review [J].
Alqahtany, Leen Yahya ;
Alsharif, Arwa ;
Alsharif, Abdulaziz ;
Alanazi, Omar ;
Altaf, Manaf ;
Kaleemullah, Ahlam ;
Alsaedi, Lana ;
Wasaya, Hanan Ismail ;
Alharbi, Abrar Hassan ;
Bawazir, Osama .
PEDIATRIC REPORTS, 2025, 17 (01)