ABSTRACT 727

Abstract

Background and aims: Necrotizing Enterocolitis (NEC) is a devastating disease affecting up to 5% infants admitted to neonatal-units. Mortality in patients requiring laparotomy is as high as 50%. Whilst most of these patients are managed in tertiary neonatal units in the UK, in our region the neonatal surgical unit is based at Alder Hey Children’s Hospital rather than at the regional neonatal unit. Following surgical intervention these patients are admitted to the paediatric intensive care unit (PICU) particularly for the sicker patients who are too unstable for transfer. Aims: To report our institution results after acute surgical NEC. Methods: Ten years retrospective review of prospectively collected data (January 2003 – December 2012). Inclusion: Infants needing laparotomy for neonatal NEC. Exclusion: NEC managed with conservative treatment, known congenital heart disease. Mortality was measured at PICU discharge and surgical follow up. PICU morbidity was measured with PIM2, length of PICU stay (LOS). Results: Over ten years period out of 186 patients were coded with NEC 109 needed laparotomy. Median gestation was 27weeks (range23-41). There were 26 deaths in the immediate post-operative period and 16 more deaths by 3 months follow up. Median PIM2 on admission was 0.07 (+/-0.02) against observed PICU mortality rate of 24% and SMR of 4.3, thus significantly under predicting mortality. Conclusions: PICU survival rates after acute surgical NEC is 70%, and 61.4% in the immediate and 3 months post-op period respectively. This is comparable to reported rates for patients managed in neonatal units.