TY - JOUR
T1 - International survey on the management of necrotizing enterocolitis
AU - Zani, Augusto
AU - Eaton, Simon
AU - Puri, Prem
AU - Rintala, Risto
AU - Lukac, Marija
AU - Bagolan, Pietro
AU - Kuebler, Joachim F.
AU - Hoellwarth, Michael E.
AU - Wijnen, Rene
AU - Tovar, Juan
AU - Pierro, Agostino
PY - 2015
Y1 - 2015
N2 - 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.
AB - 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.
KW - NEC
KW - premature infant
KW - questionnaire
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U2 - 10.1055/s-0034-1387942
DO - 10.1055/s-0034-1387942
M3 - Article
C2 - 25344942
AN - SCOPUS:84964228126
VL - 25
SP - 27
EP - 33
JO - European Journal of Pediatric Surgery
JF - European Journal of Pediatric Surgery
SN - 0939-7248
IS - 1
ER -