Abstract
Forty-six neonates were treated for necrotizing enterocolitis (NEC) between 1982 and 1987. The mean gestational age was 33.6 weeks and the mean birth weight was 1865 g. Birth weight less than 1500 g and gestational age less than 32 weeks had an adverse effect on survival. Neonates less than or equal to 30 week's gestation developed symptoms at a mean age of 10.8 days while those greater than 30 weeks developed symptoms at a mean age of 1.7 days. All infants who never had enteral feedings survived; 20 were cured with medical treatment only. Three patients underwent peritoneal lavage (2 of these survived). Twenty-two patients required surgery; the operative mortality was 9%. Four patients underwent elective surgery for primary strictures. The remaining 18 presented with acute perforation (11), obstruction (5), deterioration with medical therapy (1), or peritonitis (1). The most frequent site of perforation was the terminal ileum, while the most common site of stricture was the left colon. Seven patients were found to have strictures after prior emergency surgery. In 6 of the patients who underwent primary enterostomy, the strictures were located in the defunctionalized bowel segment. Evidence of progression of the disease, which most frequently involved the right and transverse colon, necessitated extensive resection. When performing a proximal ileostomy for acute NEC, the surgeon must be aware that the chances of conservation of the defunctionalized distal bowel segment are minimal because of progression of the disease. Complications related to resection of the ileocecal valve have been negligible. Our results with peritoneal lavage are encouraging, and our overall mortality of 13% in contrast with higher rates in earlier series reflects improvement in the management of these neonates.
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Buras R, Guzzetta P, Avery G, Navlty C (1986) Acidosis and hepatic portal venous gas: indications for surgery in necrotizing enterocolitis. Pediatrics 78: 273–277
Cikrit D, West K, Schreiner R, Grosfeld J (1986) Long-term follow-up after surgical management of necrotizing enterocolitis: sixty-three cases. J Pediatr Surg 21: 533–535
Ein SH, Marshall DG, Girvan D (1977) Peritoneal drainage under local anesthesia for perforation from necrotizing enterocolitis. J Pediatr Surg 12: 963–967
Holzman IR, Brown DR (1986) Necrotizing enterocolitis: a complication of prematurity. Seminars Perinatol 10: 208–216
Stoll BJ, Kanto WP Jr, Glass (1980) Epidemiology of necrotizing enterocolitis: a case control study. J Pediatr 96: 447–451
Kliegman RM, Fanaroff AA (1981) Neonatal enterocolitis: a nine year experience, II-Outcome, assessment. Am J Dis Child 135: 608–611
Kosloske AM (1979) Necrotizing enterocolitis in the neonate. Surg Gynecol Obstet 148: 250–269
Marchildon MB, Buck BE, Abdenour G (1982) Necrotizing enterocolitis in the unfed infant. J Pediatr Surg 17: 620–624
Mc Cormack CJ, Emmens RW, Putnam TC (1987) Evaluation of factors in high risk neonatal necrotizing enterocolitis. J Pediatr Surg 22: 488–491
Musemeche CA, Kosloske AM, Ricketts RR (1987) Enterostomy in necrotizing enterocolitis: an analysis of techniques and timing of closure. J Pediatr Surg 22: 479–483
O'Neill JA, Stahlman MT, Meng HC (1975) Necrotizing enterocolitis in the newborn: operative indications. Ann Surg 182: 274–279
Pokorny WJ, Garcia-Prats JA, Bary YN (1986) Necrotizing enterocolitis: incidence, operative care, and outcome. J Pediatr Surg 21: 1149–1154
Ricketts RR (1984) Surgical therapy for necrotizing enterocolitis. Ann Surg 200: 653–657
Robertson JFR, Azmy AF, Young DG (1987) Surgery for necrotizing enterocolitis. Br J Surg 74: 387–389
Schwartz MZ, Hayden CK, Richardson CJ, et al. (1982) A prospective evaluation of intestinal stenosis following necrotizing enterocolitis. J Pediatr Surg 17: 764–770
Schullinger JN, Mollitt DL, Vinocur LD, Santulli TV, Driscoll JM (1981) Neonatal necrotizing enterocolitis: survival, management and complications. Am J Dis Child. 135: 612–614
Walsh MC, Kleigman RM (1986) Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 33: 179–201
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Spigland, N., Yazbeck, S. & Desjardins, J.G. Surgical outcome of necrotizing enterocolitis. Pediatr Surg Int 5, 355–358 (1990). https://doi.org/10.1007/BF00177105
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DOI: https://doi.org/10.1007/BF00177105