Epidemiology and outcomes of advanced necrotising enterocolitis

Abstract

Background: A life-threatening gastrointestinal emergency, necrotising enterocolitis (NEC) presents commonly in neonates. It may be medically or surgically managed. The demographics of NEC patients in the University Hospital of Wales (UHW) and their long-term outcomes are largely unknown. Aims: To investigate factors associated with NEC, including methods of management, and correlate these with outcomes (mortality/discharge). Methods: A retrospective service evaluation comparing inborn and outborn infants diagnosed with NEC during a 5-year period, who were admitted to the Neonatal Intensive Care Unit (NICU), UHW. The Vermont-Oxford Network (VON) criteria determined the confirmed cases and the data was collected from the ‘BadgerNet’ database and IMPAX image viewer. Results: All infants with poor outcomes (mortality) were preterm. Most were born by emergency caesarean, had low APGAR scores and birth weights <1kg. There was a significant difference in the volume of feeds at diagnosis between the inborn and outborn cohort (p<0.01) and between those who died and those with better outcomes (p<0.05). Discussion: Most infants in UHW with NEC require surgical input, but surgery alone does not correlate directly with higher mortality. Low gestation/birthweight and larger volume of feeds at diagnosis are high contributors. Further research will expand the database and permit follow-up of the cohort post-discharge.