RSS-Feed abonnieren
DOI: 10.1055/s-0041-1741544
Necrotizing Enterocolitis in a Dutch Cohort of Very Preterm Infants: Prevalence, Mortality, and Long-Term Outcomes
![](https://www.thieme-connect.de/media/ejps/202201/lookinside/thumbnails/10-1055-s-0041-1741544_215936oa-1.jpg)
Abstract
Introduction To improve counseling of parents and to guide care strategies, we studied the disease course and outcomes of necrotizing enterocolitis (NEC) up to 2 years of corrected age (CA) from a multidisciplinary perspective.
Materials and Methods This was a retrospective cohort study in preterm infants (birth weight < 1,500 g, gestational age < 32 weeks), diagnosed with NEC (Bell's stage ≥ II) from 2008 through 2020. Data on prevalence, mortality, surgery, intestinal failure (IF), growth, and neurodevelopment at 2-year follow-up were separately analyzed for medically and surgically treated children.
Results Of 3,456 preterm infants, 200 (6%) were diagnosed with NEC, of whom 135 developed an indication for surgery within 7 days after the diagnosis; 28/135 died before surgery, and 37/107 died after an open-and-close procedure. An enterostomy was constructed in 62 patients and an end-to-end anastomosis in 15. The postoperative course was described for 77 patients, of whom 23 developed surgical complications (12/23 incisional hernias, 9/23 anastomotic strictures), 13/77 a short bowel, and 25/77 IF. Sixty-day survival after birth for medical NEC patients was 88% (hazard ratio [HR]: 0.698; p = 0.318), and for surgically treated NEC patients was 40% (HR: 3.729; p < 0.001). At 2-year follow-up, one patient received parenteral nutrition. Severe delay in weight for age, motor, and cognitive development was seen in 3, 6, and 2%, respectively.
Conclusion In this cohort, the mortality rate was high, especially in surgically treated NEC patients. The surgical complication rate is comparable to previous studies, but in surviving patients, persisting IF and severe delay in growth and neurodevelopment at 2 years CA were relatively rare.
* These authors share the last authorship as they contributed equally to the article.
Publikationsverlauf
Eingereicht: 18. Juli 2021
Angenommen: 13. Dezember 2021
Artikel online veröffentlicht:
10. Januar 2022
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Patel RM. Short- and long-term outcomes for extremely preterm infants. Am J Perinatol 2016; 33 (03) 318-328
- 2 Patel RM, Kandefer S, Walsh MC. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med 2015; 372 (04) 331-340
- 3 Jones IH, Hall NJ. Contemporary outcomes for infants with necrotizing enterocolitis-a systematic review. J Pediatr 2020; 220: 86-92.e3
- 4 Han SM, Knell J, Henry O. et al. Long-term outcomes of severe surgical necrotizing enterocolitis. J Pediatr Surg 2020; 55 (05) 848-851
- 5 Sheng Q, Lv Z, Xu W. et al. Short-term surgical outcomes of preterm infants with necrotizing enterocolitis: a single-center experience. Medicine (Baltimore) 2016; 95 (30) e4379
- 6 Wang H, Wang Y, Deng C, Li L, Guo C. Prediction of intestinal failure from necrotizing enterocolitis following surgery: a multicenter retrospective review. Medicine (Baltimore) 2019; 98 (19) e15568
- 7 Heida FH, Stolwijk L, Loos MH. et al. Increased incidence of necrotizing enterocolitis in the Netherlands after implementation of the new Dutch guideline for active treatment in extremely preterm infants: results from three academic referral centers. J Pediatr Surg 2017; 52 (02) 273-276
- 8 Bell MJ, Ternberg JL, Feigin RD. et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
- 9 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
- 10 WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl 2006; 450: 76-85
- 11 Bayley N. Bayley scales of infant and toddler development: Bayley-III. Harcourt assessment. Psych Corp 2006; DOI: 10.1037/t14978-000.
- 12 Johnson S, Moore T, Marlow N. Using the Bayley-III to assess neurodevelopmental delay: which cut-off should be used?. Pediatr Res 2014; 75 (05) 670-674
- 13 Berkhout DJC, Klaassen P, Niemarkt HJ. et al. Risk factors for necrotizing enterocolitis: a prospective multicenter case-control study. Neonatology 2018; 114 (03) 277-284
- 14 Alsaied A, Islam N, Thalib L. Global incidence of necrotizing enterocolitis: a systematic review and meta-analysis. BMC Pediatr 2020; 20 (01) 344
- 15 Fitzgibbons SC, Ching Y, Yu D. et al. Mortality of necrotizing enterocolitis expressed by birth weight categories. J Pediatr Surg 2009; 44 (06) 1072-1075 , discussion 1075–1076
- 16 Heida FH, Loos MH, Stolwijk L. et al. Risk factors associated with postnecrotizing enterocolitis strictures in infants. J Pediatr Surg 2016; 51 (07) 1126-1130
- 17 Broeders L, Achterberg PW, Waelput AJM. et al. Decrease in foetal and neonatal mortality in the Netherlands; comparison with other Euro-Peristat countries in 2004, 2010 and 2015 [in Dutch]. Ned Tijdschr Geneeskd 2019; 163: D3667
- 18 Shah PS, Rau S, Yoon EW. et al; Canadian Neonatal Network (CNN) Investigators. Actuarial survival based on gestational age in days at birth for infants born at <26 weeks of gestation. J Pediatr 2020; 225: 97-102.e3
- 19 Hartman HA, Pennell C, Aronoff S, Arthur LG. Effect of feeding strategies on the development of fulminant necrotizing enterocolitis. Eur J Pediatr Surg 2021; 31 (01) 49-53
- 20 Mutanen A, Pierro A, Zani A. Perioperative complications following surgery for necrotizing enterocolitis. Eur J Pediatr Surg 2018; 28 (02) 148-151
- 21 Horwitz JR, Lally KP, Cheu HW, Vazquez WD, Grosfeld JL, Ziegler MM. Complications after surgical intervention for necrotizing enterocolitis: a multicenter review. J Pediatr Surg 1995; 30 (07) 994-998 , discussion 998–999
- 22 Bælum JK, Rasmussen L, Qvist N, Ellebæk MB. Enterostomy complications in necrotizing enterocolitis (NEC) surgery, a retrospective chart review at Odense University Hospital. BMC Pediatr 2019; 19 (01) 110
- 23 Fallon EM, Mitchell PD, Nehra D. et al. Neonates with short bowel syndrome: an optimistic future for parenteral nutrition independence. JAMA Surg 2014; 149 (07) 663-670
- 24 Belza C, Wales PW. Multidisciplinary management in pediatric ultrashort bowel syndrome. J Multidiscip Healthc 2020; 13: 9-17
- 25 Pascal A, Govaert P, Oostra A, Naulaers G, Ortibus E, Van den Broeck C. Neurodevelopmental outcome in very preterm and very-low-birthweight infants born over the past decade: a meta-analytic review. Dev Med Child Neurol 2018; 60 (04) 342-355
- 26 Geurts HM, Huizinga M. Aandacht en executieve functies. Klinische kinderneuropsychologie. Amsterdam: Boom; 2011: 169-188
- 27 Karlberg J, Albertsson-Wikland K. Growth in full-term small-for-gestational-age infants: from birth to final height. Pediatr Res 1995; 38 (05) 733-739
- 28 World Health Organization. International statistical classification of diseases and related health problems, tenth revision, 2nd ed. 2004
- 29 Meijers-IJsselstijn H, Rings EHHM, Tibboel D. Het kortedarmsyndroom bij kinderen. Tijdschrift voor kindergeneeskunde 2006; 74 (04) 159-163
- 30 Duggan CP, Jaksic T. Pediatric intestinal failure. N Engl J Med 2017; 377 (07) 666-675
- 31 Kargl S, Wagner O, Pumberger W. Ileostomy Complications in infants less than 1500 grams – frequent but manageable. J Neonatal Surg 2017; 6 (01) 4