Conservative Management of Necrotizing Enterocolitis in Newborns: Incidence and Management of Intestinal Strictures
Infographic · Nov 2024 · 1 min read
In brief
In brief
Retrospective study of 126 neonates with NEC managed conservatively found 19% developed post-NEC strictures requiring delayed surgery. Most strictures occurred in the colon and were successfully treated with primary anastomosis, with favorable outcomes and minimal complications when surgery was deferred until hemodynamic stability.
- 19% of neonates with conservatively managed NEC develop post-NEC strictures, typically diagnosed 38 days after the acute episode
- Two-thirds of post-NEC strictures occur in the cecum, ascending, and transverse colon; all were managed with primary anastomosis
- 25% of post-NEC strictures are asymptomatic and detected only by screening contrast enema, supporting routine surveillance imaging
- Delayed surgical intervention for post-NEC strictures allows hemodynamic stability, shorter resections, and favorable outcomes
- Conservative NEC management is feasible in 57.5% of cases, with low mortality when strictures are managed electively
Written by the GCMD Library team from the infographic.
Rach Mena, Gabriela Guillén, Sergio Lopez-Fernandez, Marta Martos Rodríguez, César W Ruiz, Alicia Montaner-Ramon, Manuel López, José A Molino
Background: Necrotizing enterocolitis (NEC) is one of the main causes of acute abdomen in neonates. Surgical treatment entails important morbidity and mortality and conservative management, when possible, offers better outcomes. Post-NEC intestinal strictures are one of the main complications.
Methods: Retrospective analysis from June 2011 to November 2022 of post-NEC strictures (PNS) after conservative management of neonates diagnosed with NEC (modified Bell stage IIA or higher) at a tertiary neonatal surgery center.
Results: Out of 219 NEC, 126 received initial conservative management (57.5%), 24 (19%) of which eventually underwent surgery for PNS. Average gestational age and weight at birth of our cohort were 31.3 ± 4.9 weeks and 1,694 ± 1,009 g.PNS diagnosis was made 38.4 ± 16.5 days after the NEC episode. 6/24 (25%) were asymptomatic and diagnosed by screening enema, 11 (46%) presented signs of intestinal obstruction before the enema could be performed and 7 (29%) after a normal previous protocol study.Median age at PNS surgery was 56 ± 17.9 days. A total of 2/3 strictures were found in cecum, ascendent, and transverse colon. Primary resection and anastomosis were performed in all cases. Feeds were restarted on postoperative day 4.3 ± 2.9. Two cases presented anastomotic complications (1 dehiscence and 1 stenosis), and no deaths were recorded.
Conclusions: PNS is a frequent complication after conservative management. Deffered surgical treatment after the acute NEC episode is resolved allows for safer surgeries (since patients have reached hemodynamical stability and overcome septic shock), shorter resections, and favorable postoperative outcomes.