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 280/7 to 366/7 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%; 280/7 to 366/7 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%; 280/7 to 366/7 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.
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Acknowledgements
The CHNC (http://www.thechnc.org) has partnered with Children’s Hospital Association, Inc. (Overland Park, KS; Alexandria, VA) in order to design, launch and maintain the CHND. We are indebted to the following institutions that serve infants and their families, and these institutions also have invested in and continue to participate in the CHND. For more information about CHND, please contact Kate Conrad, Vice President (chnd@childrenshospitals.org). We also thank the site sponsors of the CHND for their investments in this program. The site sponsors for the CHND are:
1 Children's Healthcare of Atlanta at Egleston, Atlanta, GA (Francine Dykes, Anthony Piazza)
2 Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA (Gregory Sysyn)
3 Children's Hospital of Alabama, Birmingham, AL (Carl Coghill)
4 Le Bonheur Children's Hospital, Memphis, TN (Ramasubbareddy Dhanireddy)
5 Boston Children’s Hospital, Boston, MA (Anne Hansen)
6 Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL (Karna Murthy)
7 Nationwide Children's Hospital, Columbus, OH (Kristina Reber)
8 Children's Medical Center Dallas, Dallas, TX (Rashmin Savani)
9 Children's Hospital Colorado, Aurora, CO (Theresa Grover)
10 Children’s Hospital of Michigan, Detroit, MI (Girija Natarajan)
11 Cook Children's Medical Center, Fort Worth, TX (Jonathan Nedrelow, Annie Chi)
12 Texas Children's Hospital, Houston, TX (Steve Welty)
13 Children's Mercy Hospitals & Clinics, Kansas City, MO (Eugenia Pallotto)
14 Arkansas Children's Hospital, Little Rock, AR (Becky Rodgers, Robert Lyle)
15 Children’s Hospital Los Angeles, Los Angeles, CA (Lisa Kelly*, Steven Chin)
16 UCSF Benioff Children's Hospital Oakland, Oakland, CA (David Durand, Jeanette Asselin, Priscilla Joe)
17 The Children's Hospital of Philadelphia, Philadelphia, PA (Jacquelyn Evans, Michael Padula)
18 Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA (Beverly Brozanski)
19 St Louis Children's Hospital, St Louis, MO (Joan Rosenbaum, Tasmin Najaf, Amit Mathur, Rakesh Rao)
20 All Children's Hospital, St. Petersburg, FL (Victor McKay)
21 Rady Children's Hospital San Diego, San Diego, CA (Mark Speziale)
22 Children's National Medical Center, Washington, DC (Billie Short)
23 Alfred I. duPont Hospital for Children, Wilmington, DE (Kevin Sullivan)
24 Primary Children’s Hospital, Salt Lake City, UT (Donald Null, Robert DiGeronimo)
25 Children’s Hospital of Wisconsin, Milwaukee, WI (Michael Uhing)
26 Children's Hospital and Medical Center, Omaha, NE (Lynne Willett, John Grebe)
27 Florida Hospital for Children, Orlando, FL (Rajan Wadhawan)
28 Seattle Children's, Seattle, WA (Elizabeth Jacobson Misbe)
*deceased
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Dr Karna Murthy received a portion of salary support from CHA in 2012 to oversee analyses using CHND. Dr Jacquelyn R Evans received a stipend from CHA to oversee analyses using CHND in 2012. Ms Jeanette M Asselin received a portion of salary support from CHA from 2011–13 to maintain operations of CHND. The other authors declare no conflict of interests.
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Murthy, K., Yanowitz, T., DiGeronimo, R. et al. Short-term outcomes for preterm infants with surgical necrotizing enterocolitis. J Perinatol 34, 736–740 (2014). https://doi.org/10.1038/jp.2014.153
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DOI: https://doi.org/10.1038/jp.2014.153
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