Pediatric Surgery International

, Volume 26, Issue 6, pp 607–609 | Cite as

Interval between clinical presentation of necrotizing enterocolitis and bowel perforation in neonates

  • Tasnim A. NajafEmail author
  • Neeta A. Vachharajani
  • Brad W. Warner
  • Akshaya J. Vachharajani
Original Article



To define the interval between clinical presentation of necrotizing enterocolitis (NEC) and bowel perforation in neonates.


Charts of neonates with discharge diagnosis of NEC (n = 124) from our NICU during 2004–2008 were retrospectively reviewed. Demographic data were collected. Acute episode of NEC was defined as the interval between clinical presentations to resumption of enteral feeds. Neonates are followed, as a standard of care, clinically and radiologically until resumption of enteral feeds at the discretion of the attending clinician. Abdominal radiograph results were reviewed serially to determine the interval between clinical presentation and bowel perforation using pneumoperitoneum as the surrogate radiological marker. Histological report of resected bowel specimens was reviewed for coagulative necrosis as evidence of NEC and to exclude spontaneous intestinal perforation (SIP). Neonates with stage 1 NEC and SIP were excluded from the results.


105 neonates with stage 2 NEC were included in the study. Forty-six needed surgical treatment (group 2) and 59 did not need surgery (group 1). Twenty-six (26/46, 56%) group 2 neonates had bowel perforation and hence required surgery. Pneumoperitoneum was noted at a median interval of 1 day after presentation of symptoms. Twenty neonates in group 2 needed surgery for clinical indications including worsening clinical examination, thrombocytopenia or persistent metabolic acidosis. Fifty-nine neonates (group 1) were treated with bowel rest, antibiotics and parenteral nutrition. Group 2 neonates were significantly more premature, weighed less and had less radiographs than group 1 neonates. Mortality was significantly higher in group 2 compared to group 1.


Bowel perforation occurs at a median interval of 1 day after clinical presentation of NEC. Neonates not needing surgery for their disease are exposed to significantly more radiographs than those needing surgery. Radiological evaluation can be safely minimized or eliminated after 2 days of presentation.


Necrotizing enterocolitis Radiation exposure Neonate 



We thank Amy Distler, R.N. and Gina Meyers, R.N. for providing the list of neonates with NEC.

Conflict of interest statement

The authors declare no conflict of interest.


  1. 1.
    Rowe MI et al (1994) Necrotizing enterocolitis in the extremely low birth weight infant. J Pediatr Surg 29(8):987–990 (discussion 990–991)CrossRefPubMedGoogle Scholar
  2. 2.
    Frey EE et al (1987) Analysis of bowel perforation in necrotizing enterocolitis. Pediatr Radiol 17(5):380–382CrossRefPubMedGoogle Scholar
  3. 3.
    Bell MJ et al (1978) Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 187(1):1–7CrossRefPubMedGoogle Scholar
  4. 4.
    Walsh MC, Kliegman RM (1986) Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin N Am 33(1):179–201Google Scholar
  5. 5.
    Guthrie SO et al (2003) Necrotizing enterocolitis among neonates in the United States. J Perinatol 23(4):278–285CrossRefPubMedGoogle Scholar
  6. 6.
    Lin PW, Stoll BJ (2006) Necrotising enterocolitis. Lancet 368(9543):1271–1283CrossRefPubMedGoogle Scholar
  7. 7.
    Ng S (2001) Necrotizing enterocolitis in the full-term neonate. J Paediatr Child Health 37(1):1–4CrossRefPubMedGoogle Scholar
  8. 8.
    Wilson-Costello D et al (1996) Radiation exposure from diagnostic radiographs in extremely low birth weight infants. Pediatrics 97(3):369–374PubMedGoogle Scholar
  9. 9.
    Kosloske AM (1994) Indications for operation in necrotizing enterocolitis revisited. J Pediatr Surg 29(5):663–666CrossRefPubMedGoogle Scholar
  10. 10.
    Di Napoli A et al (2004) Inter-observer reliability of radiological signs of necrotising enterocolitis in a population of high-risk newborns. Paediatr Perinat Epidemiol 18(1):80–87CrossRefPubMedGoogle Scholar
  11. 11.
    Sutton PM et al (1998) Ionising radiation from diagnostic x rays in very low birthweight babies. Arch Dis Child Fetal Neonatal Ed 78(3):F227–F229CrossRefPubMedGoogle Scholar
  12. 12.
    Lai TT, Bearer CF (2008) Iatrogenic environmental hazards in the neonatal intensive care unit. Clin Perinatol 35(1):163–181, ixGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Tasnim A. Najaf
    • 1
    Email author
  • Neeta A. Vachharajani
    • 2
  • Brad W. Warner
    • 3
  • Akshaya J. Vachharajani
    • 1
  1. 1.Department of Pediatrics, Newborn MedicineWashington University in St. LouisSt. LouisUSA
  2. 2.Department of Abdominal SurgeryWashington University in St. LouisSt. LouisUSA
  3. 3.Department of SurgeryWashington University in St. LouisSt. LouisUSA

Personalised recommendations