#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Necrotizing enterocolitis in the Perinatological Centre of the University Hospital Hradec Králové in 2010–2017


Authors: O. Dvořák 1;  R. Štichhauer 2,3;  A. Šafus 2,3;  T. Matějek 1;  J. Koudelka 2;  Z. Kokštein 1,3;  J. Malý 1,3
Authors‘ workplace: Dětská klinika, Fakultní nemocnice, Hradec Králové 1;  Oddělení dětské chirurgie a traumatologie, Fakultní nemocnice, Hradec Králové 2;  Lékařská fakulta, Univerzita Karlova, Hradec Králové 3
Published in: Čes-slov Pediat 2018; 73 (8): 486-493.
Category:

Overview

Introduction:

Necrotizing enterocolitis (NEC) is a serious inflammatory disease affecting predominantly immature newborns. NEC ranges from moderate stages with mucosal intestine impairment to catastrophic illness with impairment of the entire alimentary canal including its perforation, development of peritonitis and shock. Despite of care improvement NEC remains the leading cause of morbidity and mortality in premature newborns.

Methods:

Retrospective cohort analysis.

Results:

During the years 2010–2017, 100 233 newborns were born in the region served by the Perinatological Centre of the University Hospital in Hradec Králové. This includes 7165 newborns with birth weight <2500 g, 907 newborns with birth weight <1500 g and 119 newborns with birth weight <750 g. NEC classification (IIa and higher) according to the modified Bell’s scale was diagnosed in total 86 cases, corresponding to 0.86‰ incidence.

NEC incidence was 5.6% in weight category <1500 g, 10.5% in weight category <1000 g and 12.6% in weight category <750 g. Lethality of newborns was 53% in weigh category <750 g, 24.5% in weight category <1500 g and 23% in the entire group of NEC patients. Gestational age-related lethality was 33.3% for newborns born between 24th and 28th week of gestation, 22.7% for newborns born between 29th and 32nd week of gestation, and 10.7% for newborns born after 33rd week of gestation. NEC stage II classification according to the modified Bell’s scale was diagnosed 58 times in total, stage III was diagnosed 28 times in total.

In total, 22 patients were treated conservatively and 64 patients underwent surgical treatment. The overall lethality was 4.5% among the conservatively treated patients and 30% among the surgically treated patients. The average length of hospitalization was 49 days among the conservatively treated patients and 84 days among the surgically treated patients.

Conclusion:

Our results are comparable to those published in other studies in Western Europe and North America. Although we can see slight decrease of the NEC incidence in our region during the last several years, necrotizing enterocolitis remains a very serious disease that fundamentally affects the survival and long-term outcome of premature newborns.

KEY WORDS:

necrotising enterocolitis, NEC, surgery, stoma, incidence


Sources

1. Obladen M. Necrotizing enterokolitis – 150 years of fruitless search for the cause. Neonatology 2009; 96: 203–210.

2. Holman RC, Stoll BJ, Curns AT, et al. Necrotising enterocolitis hospitalisations among neonates in the United States. Paediatr Perinat Epidemiol 2006; 20: 498–506.

3. Hull MA, Fisher JG, Gutierrez IM, et al. Mortality and management of surgical necrotizing enterocolitis in very low birth weight neonates: a prospective cohort study. J Am Coll Surg 2014; 218: 1148–1155.

4. Battersby C, Santhalingam T, Costeloe K, Modi N. Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review. Arch Dis Child Fetal Neonatal Ed 2018; 103: F182-F189.

5. Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med 2011; 364: 255–264.

6. Rees CM, Pierro A, Eaton S. Neurodevelopmental outcomes of neonates with medically and surgically treated necrotizing enterocolitis. Arch Dis Child Fetal Neonatal Ed 2007; 92: F193–F198.

7. Fullerton BS, Hong CR, Velazco CS, et al. Severe neurodevelopmental disability and healthcare needs among survivors of medical and surgical necrotizing enterocolitis: A prospective cohort study. J Pediatr Surg 2017. Oct 12. pii: S0022-3468(17)30651-6. doi: 10.1016/j.jpedsurg.2017.10.029.

8. Duggan CP, Jaksic T. Pediatric intestinal failure. N Engl J Med 2017; 377: 666–675.

9. Patel RM, Denning PW. Intestinal microbiota and its relationship with necrotizing enterocolitis. Pediatr Res 2015; 78: 232–238.

10. Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187: 1–7.

11. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33: 179–201.

12. Faingold R, Daneman A, Tomlinson G, et al. Necrotizing enterocolitis: assessment of bowel viability with color doppler US. Radiology 2005; 235: 587–594.

13. Stey A, Barnert ES, Tseng CH, et al. Outcomes and costs of surgical treatments of necrotizing enterocolitis. Pediatrics 2015; 135: e1190–e1197.

14. Rygl M, Čunát V, Pýcha K, et al. Nekrotizující enterokolitida u extrémně nezralých novorozenců - možnosti chirurgické léčby. Rozhl Chir 2004; 83: 629–634.

15. Malý J, Melek J, Bréšková P, et al. Variabilita klinické manifestace norovirové infekce u novorozence – od perakutní nekrotizující enterokolitidy po asymptomatický průběh. Čes-slov Pediat 2012; 67: 178–186.

16. Kalousová J, Fryč R. Nekrotizující enterokolitida. In: Šnajdauf J, Škába R (eds). Dětská chirurgie. Praha: Galén, 2005.

17. Hong CR, Fullerton BS, Mercier CE, et al. Growth morbidity in extremely low birth weight survivors of necrotizing enterocolitis at discharge and two-year follow-up. J Pediatr Surg 2018; 53: 1197–1202.

18. Mowitz ME, Dukhovny D, Zupancic JAF. The cost of necrotizing enterocolitis in premature infants. Semin Fetal Neonatal Med 2018; 23: 416–419.

19. Neu J, Modi N, Caplan M. Necrotizing enterocolitis comes in different forms: Historical perspectives and defining the disease. Semin Fetal Neonatal Med 2018; 23: 370–373.

20. Rose AT, Patel RM. A critical analysis of risk factors for necrotizing enterocolitis. Semin Fetal Neonatal Med 2018; 23: 374–379.

21. Thakkar HS, Lakhoo K. The surgical management of necrotising enterocolitis (NEC). Early Hum Dev 2016; 97: 25–28.

22. Haricharan RN, Gallimore JP, Nasr A. Primary anastomosis or ostomy in necrotizing enterocolitis? Pediatr Surg Int 2017; 33: 1139–1145.

23. Zani A, Lauriti G, Li Q, Pierro A. The timing of stoma closure in infants with necrotizing enterocolitis: A systematic review and meta-analysis. Eur J Pediatr Surg 2017; 27: 7–11.

24. Banerjee DB, Vithana H, Sharma S, Tsang TTM. Outcome of stoma closure in babies with necrotising enterocolitis: early vs late closure. Pediatr Surg Int 2017; 33: 783–786.

Labels
Neonatology Paediatrics General practitioner for children and adolescents
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#