Abstract
The Royal College of Surgeons have proposed using outcomes from necrotising enterocolitis (NEC) surgery for revalidation of neonatal surgeons. The aim of this study was therefore to calculate the number of infants in the UK/Ireland with surgical NEC and describe outcomes that could be used for national benchmarking and counselling of parents. A prospective nationwide cohort study of every infant requiring surgical intervention for NEC in the UK was conducted between 01/03/13 and 28/02/14. Primary outcome was mortality at 28-days. Secondary outcomes included discharge, post-operative complication, and TPN requirement. 236 infants were included, 43(18%) of whom died, and eight(3%) of whom were discharged prior to 28-days post decision to intervene surgically. Sixty infants who underwent laparotomy (27%) experienced a complication, and 67(35%) of those who were alive at 28 days were parenteral nutrition free. Following multi-variable modelling, presence of a non-cardiac congenital anomaly (aOR 5.17, 95% CI 1.9–14.1), abdominal wall erythema or discolouration at presentation (aOR 2.51, 95% CI 1.23–5.1), diagnosis of single intestinal perforation at laparotomy (aOR 3.1 95% CI 1.05–9.3), and necessity to perform a clip and drop procedure (aOR 30, 95% CI 3.9–237) were associated with increased 28-day mortality. These results can be used for national benchmarking and counselling of parents.
Highlights
Introduction3.1 95% CI 1.05–9.3), and necessity to perform a clip and drop procedure (aOR 30, 95% CI 3.9–237) were associated with increased 28-day mortality
Following multi-variable modelling, presence of a non-cardiac congenital anomaly, abdominal wall erythema or discolouration at presentation, diagnosis of single intestinal perforation at laparotomy
Whilst their work provides a robust overview, they do not report nuanced data relating to intra-operative findings or management strategies, making it more difficult to fully assess the burden of disease associated with surgical Necrotising enterocolitis (NEC)
Summary
3.1 95% CI 1.05–9.3), and necessity to perform a clip and drop procedure (aOR 30, 95% CI 3.9–237) were associated with increased 28-day mortality These results can be used for national benchmarking and counselling of parents. In 2011, when the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report identified that “difficulty in decision making during both medical management and the decision to operate in babies with NEC”3 was a key factor in limiting outcomes for infants with NEC in the UK, there existed no national data collection system in the UK Without such data, it is impossible to robustly benchmark outcomes for infants with surgical NEC in the UK and Ireland, or for the Royal College of Surgeons to meaningfully pursue their aim of using outcomes from infants with surgical NEC as a contributor to revalidation of neonatal surgeons. It is exceptionally difficult to accurately counsel parents of infants with NEC
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