Risk Factors of Surgical Necrotizing Enterocolitis: A Cohort Study

Abstract

Objective: To find risk factors of surgical necrotizing enterocolitis (NEC) and early detection. Materials and Methods: The present study was a retrospective cohort study that reviewed all patients with NEC in Chiang Mai University Hospital between January 2009 and December 2016. Major gastrointestinal anomalies were excluded. Associated factors for surgical NEC were reviewed and analyzed. Results: One hundred seventy-two NEC patients were identified. Seven patients were excluded due to an indefinite diagnosis of NEC and major gastrointestinal (GI) anomalies. One hundred sixty-five patients were included in the present study. Thirty-nine patients (23.6%) were in the surgical NEC group, and 126 (76.4%) patients in the non-surgical NEC group. In the multivariable analyses, significant factors associated with surgical NEC were plain abdominal X-ray findings of intraperitoneal fluid (RR 3.36, p=0.001, 95% CI 1.68 to 6.73), and pneumatosis intestinalis (RR 2.69, p=0.007, 95% CI 1.30 to 5.41). The overall mortality rate of NEC was 13.9%, whereas surgical NEC had a higher mortality rate of 28.2%. Conclusion: Intraperitoneal fluid and pneumatosis intestinalis were the significant factors for prediction of perforation of NEC. Therefore, close clinical monitoring and prompt management in these patients are recommended. Keywords: Surgical necrotizing enterocolitis, Risk factors, Perforation, NEC