Neonatal necrotizing entero-colitis: A clinico-surgical study

Abstract

Objective Necrotizing enterocolitis (NEC) is most common gastrointestinal emergency among neonates admitted to the intensive care units. Aim of this study is to assess incidence, management, outcome and prognostic factors favouring survival of NEC cases. Methods A prospective study on 52 cases, age between 1 and 30days (11 full-term and 41 preterm) with NEC among neonatal intensive care unit (NICU) admissions. According to modified Bell's classification, cases were classified into 3 groups (stage I, 12), (stage II, 20) and (stage III, 20). Stages I and II treated medically, while stage III treated surgically (peritoneal drainage and/or laparotomy). All results were statistically analysed using chi-square and ANOVA tests by SPSS, v16. Results Incidence of NEC in our study was 8.5% with mean presenting age (8.9days), mean birth-weight (2200grams) and mean gestational-age (34.9weeks). The commonest presenting feature was abdominal distension (82.7%), followed by respiratory distress (76.9%) and neonatal sepsis (61.5%). Thrombocytopenia and hyponatraemia were present in all cases, metabolic-acidosis in 92.3% and CRP was positive in 78.9%. Free fluid was present in 73.1%, pneumo-peritoneum in 38.5% and pneumatosis-intestinalis in 15.4%. Medical treatment was sufficient in 20 out of 32 cases of stage I and II (62.5% survival). Between the 20 cases of stage III; 6 cases subjected to immediate Laparotomy (33.3% survival), 14 cases treated with peritoneal drainage, 4 survived, 2 cases were in need for subsequent laparotomy and survived. Stoma formation was done in 4 cases; resection with primary anastomosis was done in 1 case while primary repair was done in 3 cases. The overall survival in the study was 53.85%. Conclusion Early diagnosis and intensive medical and surgical treatment were mandatory to minimize both morbidity and mortality from NEC. Surgical management should be determined according to the special circumstances of each case. However, the optimum choice between peritoneal drainage and laparotomy remains controversial. Gestational age, birth weight, age at admission, and treatment modality are definite prognostic factors as regard morbidity and mortality of patients with NEC.