Postoperative neonatal necrotizing enterocolitis

Abstract

Neonatal necrotizing enterocolitis (NEC) classically occurs in stressed premature newborns within the first ten days of life. Although it has been sporadically described in other settings, it has not been frequently cited as a postoperative complication. This paper presents eleven surgical infants whose postoperative course was complicated by the development of NEC. During the last 5 yr, 11 newborns (mean 2.4 kg.) have been treated for postoperative NEC. Each of these had undergone a major operation within the first week of life. Diagnoses included gastroschisis (7), omphalocele (1), jejunal atresia (1), aganglionosis (1), and malrotation with duodenal web (1). The mean age at onset of symptoms was 36 days (range 5–136 days) and an average of 29 days postoperatively (range 5–120 days). NEC was documented in each case by the presence of pneumatosis intestinalis or surgical and/or autopsy specimen. Four infants responded to medical therapy. Seven required operation, three of whom had involvement of the entire midgut. Five of the eleven neonates (46%) died of overwhelming sepsis. Of the remaining six, two require T.P.N. for survival (15 and 16 months old) and two additional require frequent hospitalization for diarrhea (morbidity 67%). NEC resulted in substantial morbidity and mortality in these surgical neonates. It occurred late in the postoperative period and pursued a virulent course. In only three infants could etiologic factors be identified. Two occurred after attempts at closure of abdominal wall defects and the third suffered hypoxia prior to the onset of symptoms. In each of these, NEC became apparent early postoperatively (Avg. 7th postoperative day). In the remaining eight, however, contributing factors could not be identified and onset of symptoms occurred late (Avg. 39th postoperative day). The preponderance of abdominal wall defects suggests a possible increased susceptibility in these infants. NEC should be included in the differential diagnosis of gastrointestinal symptoms in postoperative neonates. Neonatal necrotizing enterocolitis (NEC) classically occurs in stressed premature newborns within the first ten days of life. Although it has been sporadically described in other settings, it has not been frequently cited as a postoperative complication. This paper presents eleven surgical infants whose postoperative course was complicated by the development of NEC. During the last 5 yr, 11 newborns (mean 2.4 kg.) have been treated for postoperative NEC. Each of these had undergone a major operation within the first week of life. Diagnoses included gastroschisis (7), omphalocele (1), jejunal atresia (1), aganglionosis (1), and malrotation with duodenal web (1). The mean age at onset of symptoms was 36 days (range 5–136 days) and an average of 29 days postoperatively (range 5–120 days). NEC was documented in each case by the presence of pneumatosis intestinalis or surgical and/or autopsy specimen. Four infants responded to medical therapy. Seven required operation, three of whom had involvement of the entire midgut. Five of the eleven neonates (46%) died of overwhelming sepsis. Of the remaining six, two require T.P.N. for survival (15 and 16 months old) and two additional require frequent hospitalization for diarrhea (morbidity 67%). NEC resulted in substantial morbidity and mortality in these surgical neonates. It occurred late in the postoperative period and pursued a virulent course. In only three infants could etiologic factors be identified. Two occurred after attempts at closure of abdominal wall defects and the third suffered hypoxia prior to the onset of symptoms. In each of these, NEC became apparent early postoperatively (Avg. 7th postoperative day). In the remaining eight, however, contributing factors could not be identified and onset of symptoms occurred late (Avg. 39th postoperative day). The preponderance of abdominal wall defects suggests a possible increased susceptibility in these infants. NEC should be included in the differential diagnosis of gastrointestinal symptoms in postoperative neonates.