Short-term outcomes for preterm infants with surgical necrotizing enterocolitis

K. Murthy, T. D. Yanowitz, R. Digeronimo, F. D. Dykes, I. Zaniletti, J. Sharma, K. M. Sullivan, J. Mirpuri, J. R. Evans, R. Wadhawan, A. Piazza, I. Adams-Chapman, J. M. Asselin, B. L. Short, M. A. Padula, D. J. Durand, E. K. Pallotto, K. M. Reber

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Abstract

Objective:To characterize the population and short-term outcomes in preterm infants with surgical necrotizing enterocolitis (NEC).Study Design:Preterm infants with surgical NEC were identified from 27 hospitals over 3 years using the Children's Hospitals Neonatal Database; infants with gastroschisis, volvulus, major congenital heart disease or surgical NEC that resolved prior to referral were excluded. Patient characteristics and pre-discharge morbidities were stratified by gestational age (<28 vs 28 0/7 to 36 6/7 weeks' gestation).Result:Of the 753 eligible infants, 60% were born at <28 weeks' gestation. The median age at referral was 14 days; only 2 infants were inborn. Male gender (61%) was overrepresented, whereas antenatal steroid exposure was low (46%). Although only 11% had NEC totalis, hospital mortality (<28 weeks' gestation: 41%; 28 0/7 to 36 6/7 weeks' gestation: 32%, P=0.02), short bowel syndrome (SBS)/intestinal failure (IF) (20% vs 26%, P=0.06) and the composite of mortality or SBS/IF (50% vs 49%, P=0.7) were prevalent. Also, white matter injury (11.7% vs 6.6%, P=0.02) and grade 3 to 4 intraventricular hemorrhages (23% vs 2.7%, P<0.01) were commonly diagnosed. After referral, the median length of hospitalization was longer for survivors (106 days; interquartile range (IQR) 79, 152) relative to non-survivors (2 days; IQR 1,17; P<0.001). These survivors were prescribed parenteral nutrition infrequently after hospital discharge (<28 weeks': 5.2%; 28 0/7 to 36 6/7 weeks': 9.9%, P=0.048).Conclusion:After referral for surgical NEC, the short-term outcomes are grave, particularly for infants born <28 weeks' gestation. Although analyses to predict outcomes are urgently needed, these data suggest that affected infants are at a high risk for lengthy hospitalizations and adverse medical and neuro-developmental abnormalities.

Original languageEnglish (US)
Pages (from-to)736-740
Number of pages5
JournalJournal of Perinatology
Volume34
Issue number10
DOIs
StatePublished - Oct 11 2014

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ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Murthy, K., Yanowitz, T. D., Digeronimo, R., Dykes, F. D., Zaniletti, I., Sharma, J., Sullivan, K. M., Mirpuri, J., Evans, J. R., Wadhawan, R., Piazza, A., Adams-Chapman, I., Asselin, J. M., Short, B. L., Padula, M. A., Durand, D. J., Pallotto, E. K., & Reber, K. M. (2014). Short-term outcomes for preterm infants with surgical necrotizing enterocolitis. Journal of Perinatology, 34(10), 736-740. https://doi.org/10.1038/jp.2014.153