Surgical necrotizing enterocolitis (NEC): Association between surgical indication, timing, and outcomes | 13 months | Prospective cohort study | Infants with NEC requiring surgery at 27 pediatric surgical centers in the UK and Ireland identified with British Association of Paediatric Surgeons Congenital Anomalies Surveillance System (BAPS-CASS) | Total of 133 infants were surgically treated for NEC | Median gestation at birth - 27 weeks | birthweight - 950 grams | age at presentation - 11 days | Indications for surgery | 50% bowel perforation | 15% suspected necrotic bowel without bowel perforation | 32% failed medical management | Failed medical treatment is | the strongest predictor of death at 28 days post-surgery | associated with increased time to surgery of 30.28 hours compared to other groups | Conclusion: Earlier intervention may improve outcomes for some patients with NEC but more research is needed | https://pubmed.ncbi.nlm.nih.gov/34090670/ | Source: University of Southampton, Southampton and University of Oxford, Oxford UK | @EmTombash @emenclsco @NodGerardo
Surgical necrotizing enterocolitis: Association between surgical indication, timing, and outcomes
Infographic · Nov 2021 · 1 min read
In brief
In brief
This UK-Ireland prospective study of 133 infants with surgical NEC found that delayed intervention for failed medical management was associated with significantly worse outcomes compared to early surgery for perforation. Earlier surgical intervention in medically refractory cases may improve survival and reduce parenteral nutrition dependency.
- Failed medical management as surgical indication predicts 4.5× higher risk of death or PN dependence at 28 days versus perforation alone
- Infants operated for failed medical treatment wait 30 hours longer for surgery compared to those with documented perforation
- Earlier surgical intervention in medically refractory NEC may improve outcomes before progression to overt treatment failure
- Bowel perforation remains most common surgical indication (50% of cases) but carries better prognosis than delayed intervention
- Despite neonatal care advances, NEC outcomes remain stagnant—surgical timing may be modifiable factor to reduce mortality and morbidity
Written by the GCMD Library team from the infographic.
A teal-colored infographic divided into sections with yellow and white text boxes. Features cartoon illustrations of four diverse infant faces at the top, a calendar icon on the left, and a hand with scalpel icon on the right. Uses contrasting yellow highlights for key statistics and a yellow conclusion box at bottom.
Background/Purpose: Despite improvements in neonatal care the outcomes of Necrotizing Enterocolitis (NEC) remain unchanged over previous decades. The study aims to explore whether different indications for surgical intervention in NEC are associated with timing of surgery and outcomes. Methods: Population-based, prospective, observational study of all 27 paediatric surgical centres in the United Kingdom and Ireland identified using the British Association of Paediatric Surgeons Congenital Anomalies Surveillance System from 1st February 2013 to 28th February 2014. Infants were included if they had NEC and underwent first surgical intervention within 7 days of diagnosis. Primary outcomes were death, parenteral nutrition requirement or a composite outcome of death or PN requirement at 28 days post surgery.
Results: There were 133 infants meeting inclusion criteria. Indications for surgery were bowel perfora- tion (n = 67), suspected necrotic bowel without bowel perforation and not deemed to have failed medical management (n = 20), those who had failed medical management (n = 42) and a palpable mass without any other indication (n = 4). Failed medical treatment as an indication for surgery was associated with an increased time to surgery of 30.28 (95% CI 13.46–47.10) hours from those whose indication was perfo- ration and was also the strongest predictor of PN requirement or death at 28 days post-surgery (OR 4.54 [1.59–13.0]).
Conclusions: Failed medical treatment as an indication for surgery for NEC is associated with poor out- come. Earlier intervention in these infants represents a potential opportunity to improve outcomes in this population.