Surgical management of low birth weight infants with necrotizing enterocolitis

Abstract

Objective To evaluate the surgical procedures applied, and the survival of low birth weight (LBW) infants with Necrotizing enterocolitis (NEC). Methods 670 LBW infants with NEC were analyzed retrospectively from Jan. 2003 and Dec. 2013. All of the patients were divided into 2 groups according to their birth weights: extremely low birth weight (ELBW) group (<1 500 g, n=241) and LBW group (1 500 g2 500 g, n=429). Data collected include operative rates, indications for operation, operations performed, complications, and 30day survival rates. Results 197 of 670 infants with NEC underwent surgical intervention. There were 63 patients in Bell stage Ⅱ and 134 patients in Bell stage Ⅲ. The total operative rate was 29.4%. The mean gestational age was 31±2 weeks. The mean birth weight was 1 561±502 grams. The mean age at operation was 14.5±17 days. 48.5% (117/241) had surgery for NEC in ELBW group while 18.6% (80/429) in LBW group (P 0.05). 93.9% of patients were treated with primary laparotomy (10 primary anastomosis and 175 enterostomy), whereas peritoneal drainage was performed in 12 patients. The postoperative complication rate was 46.2%. The common postoperative complications were sepsis and intestinal strictures. Furthermore, there was no difference in postoperative survival rates between the groups (73.5% vs. 82.5%, P>0.05). Conclusions The surgical management plays important role in NEC treatments. Pneumoperitoneum is the most common indication for operation. The most ommon surgical procedure applied is enterostomy. It is effective to improve the postoperative survival rate especially in ELBW infants. Key words: Enterocolitis, necrotizing; Surgical procedures, operative; Neonate