Does the Timing of Surgical Intervention Impact Outcomes in Necrotizing Enterocolitis?

Objectives The optimal time for intervention in surgical necrotizing enterocolitis (sNEC) remains to be elucidated. Surgical management varies between peritoneal drain (PD), laparotomy (LAP), and PD with subsequent LAP (PD + LAP). We propose that some infants with surgical NEC benefit from late (>...

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Published in:The American surgeon 2024-09, Vol.90 (9), p.2279-2284
Main Authors: Rauh, Jessica L., Reddy, Menaka N., Santella, Nicole L., Ellison, Maryssa A., Weis, Victoria G., Zeller, Kristen A., Garg, Parvesh M., Ladd, Mitchell R.
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container_end_page 2284
container_issue 9
container_start_page 2279
container_title The American surgeon
container_volume 90
creator Rauh, Jessica L.
Reddy, Menaka N.
Santella, Nicole L.
Ellison, Maryssa A.
Weis, Victoria G.
Zeller, Kristen A.
Garg, Parvesh M.
Ladd, Mitchell R.
description Objectives The optimal time for intervention in surgical necrotizing enterocolitis (sNEC) remains to be elucidated. Surgical management varies between peritoneal drain (PD), laparotomy (LAP), and PD with subsequent LAP (PD + LAP). We propose that some infants with surgical NEC benefit from late (>48 h) operative intervention to allow for resuscitation. Methods A retrospective comparison of clinical information in infants with sNEC from 2012 to 2022 was performed. Early intervention was defined as less than 48 hours from time of NEC diagnosis to surgical intervention. Results 118 infants were identified, 92 underwent early intervention (62 LAP; 22 PD; 8 PD + LAP) and 26 underwent late intervention (20 LAP; 2 PD; 4 PD + LAP). Infants with early intervention were diagnosed younger (DOL 8 [6, 15] vs 20 [11, 26]; P=< .05) with more pneumoperitoneum (76% vs 23%; P=< .05). The early intervention group had a higher mortality (35% vs 15%; P=< .05). When excluding infants with pneumoperitoneum, the early intervention group had a higher mortality rate (10/22 (45%), 4/26 (15%); P < .05) and had more bowel resected (29 ± 17 cm vs 9 ± 8 cm; P < .05), with the same number of patients scoring above 3 on the MD7 criteria. Conclusion Infants with NEC who underwent early surgical intervention had a higher mortality and more bowel resected. While this study has a provocative finding, it is severely limited by the non-specific 48-hour cut off. However, our data suggests that a period of medical optimization may improve outcomes in infants with sNEC and thus more in-depth studies are needed.
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Surgical management varies between peritoneal drain (PD), laparotomy (LAP), and PD with subsequent LAP (PD + LAP). We propose that some infants with surgical NEC benefit from late (&gt;48 h) operative intervention to allow for resuscitation. Methods A retrospective comparison of clinical information in infants with sNEC from 2012 to 2022 was performed. Early intervention was defined as less than 48 hours from time of NEC diagnosis to surgical intervention. Results 118 infants were identified, 92 underwent early intervention (62 LAP; 22 PD; 8 PD + LAP) and 26 underwent late intervention (20 LAP; 2 PD; 4 PD + LAP). Infants with early intervention were diagnosed younger (DOL 8 [6, 15] vs 20 [11, 26]; P=&lt; .05) with more pneumoperitoneum (76% vs 23%; P=&lt; .05). The early intervention group had a higher mortality (35% vs 15%; P=&lt; .05). When excluding infants with pneumoperitoneum, the early intervention group had a higher mortality rate (10/22 (45%), 4/26 (15%); P &lt; .05) and had more bowel resected (29 ± 17 cm vs 9 ± 8 cm; P &lt; .05), with the same number of patients scoring above 3 on the MD7 criteria. Conclusion Infants with NEC who underwent early surgical intervention had a higher mortality and more bowel resected. While this study has a provocative finding, it is severely limited by the non-specific 48-hour cut off. 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Surgical management varies between peritoneal drain (PD), laparotomy (LAP), and PD with subsequent LAP (PD + LAP). We propose that some infants with surgical NEC benefit from late (&gt;48 h) operative intervention to allow for resuscitation. Methods A retrospective comparison of clinical information in infants with sNEC from 2012 to 2022 was performed. Early intervention was defined as less than 48 hours from time of NEC diagnosis to surgical intervention. Results 118 infants were identified, 92 underwent early intervention (62 LAP; 22 PD; 8 PD + LAP) and 26 underwent late intervention (20 LAP; 2 PD; 4 PD + LAP). Infants with early intervention were diagnosed younger (DOL 8 [6, 15] vs 20 [11, 26]; P=&lt; .05) with more pneumoperitoneum (76% vs 23%; P=&lt; .05). The early intervention group had a higher mortality (35% vs 15%; P=&lt; .05). When excluding infants with pneumoperitoneum, the early intervention group had a higher mortality rate (10/22 (45%), 4/26 (15%); P &lt; .05) and had more bowel resected (29 ± 17 cm vs 9 ± 8 cm; P &lt; .05), with the same number of patients scoring above 3 on the MD7 criteria. Conclusion Infants with NEC who underwent early surgical intervention had a higher mortality and more bowel resected. While this study has a provocative finding, it is severely limited by the non-specific 48-hour cut off. 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Surgical management varies between peritoneal drain (PD), laparotomy (LAP), and PD with subsequent LAP (PD + LAP). We propose that some infants with surgical NEC benefit from late (&gt;48 h) operative intervention to allow for resuscitation. Methods A retrospective comparison of clinical information in infants with sNEC from 2012 to 2022 was performed. Early intervention was defined as less than 48 hours from time of NEC diagnosis to surgical intervention. Results 118 infants were identified, 92 underwent early intervention (62 LAP; 22 PD; 8 PD + LAP) and 26 underwent late intervention (20 LAP; 2 PD; 4 PD + LAP). Infants with early intervention were diagnosed younger (DOL 8 [6, 15] vs 20 [11, 26]; P=&lt; .05) with more pneumoperitoneum (76% vs 23%; P=&lt; .05). The early intervention group had a higher mortality (35% vs 15%; P=&lt; .05). When excluding infants with pneumoperitoneum, the early intervention group had a higher mortality rate (10/22 (45%), 4/26 (15%); P &lt; .05) and had more bowel resected (29 ± 17 cm vs 9 ± 8 cm; P &lt; .05), with the same number of patients scoring above 3 on the MD7 criteria. Conclusion Infants with NEC who underwent early surgical intervention had a higher mortality and more bowel resected. While this study has a provocative finding, it is severely limited by the non-specific 48-hour cut off. However, our data suggests that a period of medical optimization may improve outcomes in infants with sNEC and thus more in-depth studies are needed.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>38794835</pmid><doi>10.1177/00031348241256054</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-3475-3444</orcidid><orcidid>https://orcid.org/0000-0001-9907-6758</orcidid><orcidid>https://orcid.org/0000-0001-5312-8452</orcidid></addata></record>
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