Short-term outcomes for preterm infants with surgical necrotizing enterocolitis

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.