International survey on the management of necrotizing enterocolitis

Augusto Zani, Simon Eaton, Prem Puri, Risto Rintala, Marija Lukac, Pietro Bagolan, Joachim F. Kuebler, Michael E. Hoellwarth, Rene Wijnen, Juan Tovar, Agostino Pierro

Research output: Contribution to journalArticlepeer-review


Aim The aim of this study is to define patterns in the management of necrotizing enterocolitis (NEC). Methods A total of 80 delegates (81% senior surgeons) from 29 (20 European) countries completed a survey at the European Pediatric Surgeons' Association 2013 annual meeting. Results Overall, 59% surgeons work in centers where >10 cases of NEC are treated per year. Diagnosis: 76% surgeons request both anteroposterior and lateral abdominal X-rays, which are performed at regular intervals by 66%; 50% surgeons also request Doppler ultrasonography; most frequently used biochemical markers are platelets (99% of surgeons), C-reactive protein (90%), and white cell count (83%). Laparoscopy is performed for diagnosis and/or treatment of NEC by only 8% surgeons. Overall, 43% surgeons reported being able to diagnose focal intestinal perforation preoperatively. Medical NEC: medical NEC is managed by surgical and neonatal teams together in most centers (84%). Most surgeons (67%) use a combination of two (51%) or three (48%) antibiotics for more than 7 days, and keep patients nil by mouth for 7 (41%) or 10 (49%) days. Surgical NEC: In extremely low-birth-weight infants (<1,000 g) with intestinal perforation, 27% surgeons opt for primary peritoneal drainage (PPD) as definitive treatment. Overall, 67% think that peritoneal drainage is important for stabilization and transport. At laparotomy, treatments vary according to NEC severity. About 75% surgeons always close the abdomen, and 29% leave a patch to prevent compartment syndrome. Postoperative management: Infants are kept nil by mouth for 5 to 7 days by 46% surgeons, more than 7 days by 42%, and less than 5 days by 12% surgeons. Most surgeons (77%) restart infants on breast milk, 11.5% on aminoacid-based formulas, and 11.5% on hydrolyzed formulas. Most surgeons (92%) follow-up NEC patients after discharge, up to 5 years of life (56%) and 65% surgeons organize a neurodevelopmental follow-up. Conclusions Many aspects of NEC management are lacking consensus and surgeons differ especially over surgical treatment of complex cases and postoperative management. Prospective multi-center studies are needed to guide an evidence-based management of NEC.

Original languageEnglish
Pages (from-to)27-33
Number of pages7
JournalEuropean Journal of Pediatric Surgery
Issue number1
Publication statusPublished - 2015


  • NEC
  • premature infant
  • questionnaire

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery


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