Multicenter retrospective study on management and outcome of newborns affected by surgical necrotizing enterocolitis

Silvana Federici, Lorenzo De Biagi, Simona Straziuso, Ernesto Leva, Giulia Brisighelli, Girolamo Mattioli, Luca Pio, Pietro Bagolan, Giorgia Totonelli, Bruno Noccioli, Elisa Severi, Pierluigi Lelli Chiesa, Gabriele Lisi, Antonino Tramontano, Carolina De Chiara, Carmine Del Rossi, Giovanni Casadio, Mario Messina, Rossella Angotti, Antonino AppignaniMirko Bertozzi, Fabio Rossi, Valeria Gabriele, Andrea Franchella, Veronica Zocca

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Necrotizing enterocolitis (NEC) is the most common surgical emergency in newborns and it is still a leading cause of death despite the improvements reached in the management of the critically ill neonate. The purpose of this study was to evaluate risk factors, surgical treatments and outcome of surgical NEC. METHODS: We retrospectively evaluated a multicentric group of 184 patients with surgical NEC over a period of 5 years (2008-2012). Indications to operation were modified NEC Bell stages IIIA or IIIB. The main outcome was measured in terms of survival and postsurgical complications. RESULTS: Data on 184 patients who had a surgical NEC were collected. The majority of patients (153) had a primary laparotomy (83%); 10 patients had peritoneal drainage insertion alone (5%) and 21 patients had peritoneal drainage followed by laparotomy (12%). Overall mortality was 28%. Patients with lower gestational age (P=0.001), lower birth weight (P=0.001), more extensive intestinal involvement (P=0.002) and cardiac diseases (P=0.012) had a significantly higher incidence of mortality. There was no statistically significant association between free abdominal air on the X-ray and mortality (P=0.407). Mortality in the drainage group was 60%, in the laparotomy group and drainage followed by laparotomy group was of 23-24% (P=0.043). There was a high incidence of stenosis (28%) in the drainage group (P=0.002). On multivariable regression, lower birth weight, feeding, bradycardia-desaturation and extent of bowel involvement were independent predictors of mortality. CONCLUSIONS: Laparotomy was the most frequent method of treatment (83%). Primary laparotomy and drainage with laparotomy groups had similar mortalities (23-24%), while the drainage alone treatment cohort was associated with the highest mortality (60%) with statistical value (P=0.043). Consequently laparotomy is highly protective in terms of survival rate. Stenosis seemed to be statistically associated with drainage. These findings could discourage the use of peritoneal drainage versus a primary laparotomy whenever the clinical conditions of patients allow this procedure.

Original languageEnglish
Pages (from-to)183-187
Number of pages5
JournalMinerva Chirurgica
Volume72
Issue number3
DOIs
Publication statusPublished - Jun 1 2017

Fingerprint

Necrotizing Enterocolitis
Laparotomy
Multicenter Studies
Drainage
Retrospective Studies
Newborn Infant
Mortality
Birth Weight
Pathologic Constriction
Free Association
Incidence
Bradycardia
Critical Illness
Gestational Age
Cause of Death
Heart Diseases
Emergencies
Survival Rate
Air
X-Rays

Keywords

  • Constriction
  • Drainage
  • Enterocolitis
  • Laparotomy
  • Mortality
  • Necrotizing
  • Pathologic

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Multicenter retrospective study on management and outcome of newborns affected by surgical necrotizing enterocolitis. / Federici, Silvana; De Biagi, Lorenzo; Straziuso, Simona; Leva, Ernesto; Brisighelli, Giulia; Mattioli, Girolamo; Pio, Luca; Bagolan, Pietro; Totonelli, Giorgia; Noccioli, Bruno; Severi, Elisa; Chiesa, Pierluigi Lelli; Lisi, Gabriele; Tramontano, Antonino; De Chiara, Carolina; Del Rossi, Carmine; Casadio, Giovanni; Messina, Mario; Angotti, Rossella; Appignani, Antonino; Bertozzi, Mirko; Rossi, Fabio; Gabriele, Valeria; Franchella, Andrea; Zocca, Veronica.

In: Minerva Chirurgica, Vol. 72, No. 3, 01.06.2017, p. 183-187.

Research output: Contribution to journalArticle

Federici, S, De Biagi, L, Straziuso, S, Leva, E, Brisighelli, G, Mattioli, G, Pio, L, Bagolan, P, Totonelli, G, Noccioli, B, Severi, E, Chiesa, PL, Lisi, G, Tramontano, A, De Chiara, C, Del Rossi, C, Casadio, G, Messina, M, Angotti, R, Appignani, A, Bertozzi, M, Rossi, F, Gabriele, V, Franchella, A & Zocca, V 2017, 'Multicenter retrospective study on management and outcome of newborns affected by surgical necrotizing enterocolitis', Minerva Chirurgica, vol. 72, no. 3, pp. 183-187. https://doi.org/10.23736/S0026-4733.17.07159-0
Federici, Silvana ; De Biagi, Lorenzo ; Straziuso, Simona ; Leva, Ernesto ; Brisighelli, Giulia ; Mattioli, Girolamo ; Pio, Luca ; Bagolan, Pietro ; Totonelli, Giorgia ; Noccioli, Bruno ; Severi, Elisa ; Chiesa, Pierluigi Lelli ; Lisi, Gabriele ; Tramontano, Antonino ; De Chiara, Carolina ; Del Rossi, Carmine ; Casadio, Giovanni ; Messina, Mario ; Angotti, Rossella ; Appignani, Antonino ; Bertozzi, Mirko ; Rossi, Fabio ; Gabriele, Valeria ; Franchella, Andrea ; Zocca, Veronica. / Multicenter retrospective study on management and outcome of newborns affected by surgical necrotizing enterocolitis. In: Minerva Chirurgica. 2017 ; Vol. 72, No. 3. pp. 183-187.
@article{3b2a4975ccb94db4959d8ec75e5bf6a6,
title = "Multicenter retrospective study on management and outcome of newborns affected by surgical necrotizing enterocolitis",
abstract = "BACKGROUND: Necrotizing enterocolitis (NEC) is the most common surgical emergency in newborns and it is still a leading cause of death despite the improvements reached in the management of the critically ill neonate. The purpose of this study was to evaluate risk factors, surgical treatments and outcome of surgical NEC. METHODS: We retrospectively evaluated a multicentric group of 184 patients with surgical NEC over a period of 5 years (2008-2012). Indications to operation were modified NEC Bell stages IIIA or IIIB. The main outcome was measured in terms of survival and postsurgical complications. RESULTS: Data on 184 patients who had a surgical NEC were collected. The majority of patients (153) had a primary laparotomy (83{\%}); 10 patients had peritoneal drainage insertion alone (5{\%}) and 21 patients had peritoneal drainage followed by laparotomy (12{\%}). Overall mortality was 28{\%}. Patients with lower gestational age (P=0.001), lower birth weight (P=0.001), more extensive intestinal involvement (P=0.002) and cardiac diseases (P=0.012) had a significantly higher incidence of mortality. There was no statistically significant association between free abdominal air on the X-ray and mortality (P=0.407). Mortality in the drainage group was 60{\%}, in the laparotomy group and drainage followed by laparotomy group was of 23-24{\%} (P=0.043). There was a high incidence of stenosis (28{\%}) in the drainage group (P=0.002). On multivariable regression, lower birth weight, feeding, bradycardia-desaturation and extent of bowel involvement were independent predictors of mortality. CONCLUSIONS: Laparotomy was the most frequent method of treatment (83{\%}). Primary laparotomy and drainage with laparotomy groups had similar mortalities (23-24{\%}), while the drainage alone treatment cohort was associated with the highest mortality (60{\%}) with statistical value (P=0.043). Consequently laparotomy is highly protective in terms of survival rate. Stenosis seemed to be statistically associated with drainage. These findings could discourage the use of peritoneal drainage versus a primary laparotomy whenever the clinical conditions of patients allow this procedure.",
keywords = "Constriction, Drainage, Enterocolitis, Laparotomy, Mortality, Necrotizing, Pathologic",
author = "Silvana Federici and {De Biagi}, Lorenzo and Simona Straziuso and Ernesto Leva and Giulia Brisighelli and Girolamo Mattioli and Luca Pio and Pietro Bagolan and Giorgia Totonelli and Bruno Noccioli and Elisa Severi and Chiesa, {Pierluigi Lelli} and Gabriele Lisi and Antonino Tramontano and {De Chiara}, Carolina and {Del Rossi}, Carmine and Giovanni Casadio and Mario Messina and Rossella Angotti and Antonino Appignani and Mirko Bertozzi and Fabio Rossi and Valeria Gabriele and Andrea Franchella and Veronica Zocca",
year = "2017",
month = "6",
day = "1",
doi = "10.23736/S0026-4733.17.07159-0",
language = "English",
volume = "72",
pages = "183--187",
journal = "Minerva Chirurgica",
issn = "0026-4733",
publisher = "Edizioni Minerva Medica S.p.A.",
number = "3",

}

TY - JOUR

T1 - Multicenter retrospective study on management and outcome of newborns affected by surgical necrotizing enterocolitis

AU - Federici, Silvana

AU - De Biagi, Lorenzo

AU - Straziuso, Simona

AU - Leva, Ernesto

AU - Brisighelli, Giulia

AU - Mattioli, Girolamo

AU - Pio, Luca

AU - Bagolan, Pietro

AU - Totonelli, Giorgia

AU - Noccioli, Bruno

AU - Severi, Elisa

AU - Chiesa, Pierluigi Lelli

AU - Lisi, Gabriele

AU - Tramontano, Antonino

AU - De Chiara, Carolina

AU - Del Rossi, Carmine

AU - Casadio, Giovanni

AU - Messina, Mario

AU - Angotti, Rossella

AU - Appignani, Antonino

AU - Bertozzi, Mirko

AU - Rossi, Fabio

AU - Gabriele, Valeria

AU - Franchella, Andrea

AU - Zocca, Veronica

PY - 2017/6/1

Y1 - 2017/6/1

N2 - BACKGROUND: Necrotizing enterocolitis (NEC) is the most common surgical emergency in newborns and it is still a leading cause of death despite the improvements reached in the management of the critically ill neonate. The purpose of this study was to evaluate risk factors, surgical treatments and outcome of surgical NEC. METHODS: We retrospectively evaluated a multicentric group of 184 patients with surgical NEC over a period of 5 years (2008-2012). Indications to operation were modified NEC Bell stages IIIA or IIIB. The main outcome was measured in terms of survival and postsurgical complications. RESULTS: Data on 184 patients who had a surgical NEC were collected. The majority of patients (153) had a primary laparotomy (83%); 10 patients had peritoneal drainage insertion alone (5%) and 21 patients had peritoneal drainage followed by laparotomy (12%). Overall mortality was 28%. Patients with lower gestational age (P=0.001), lower birth weight (P=0.001), more extensive intestinal involvement (P=0.002) and cardiac diseases (P=0.012) had a significantly higher incidence of mortality. There was no statistically significant association between free abdominal air on the X-ray and mortality (P=0.407). Mortality in the drainage group was 60%, in the laparotomy group and drainage followed by laparotomy group was of 23-24% (P=0.043). There was a high incidence of stenosis (28%) in the drainage group (P=0.002). On multivariable regression, lower birth weight, feeding, bradycardia-desaturation and extent of bowel involvement were independent predictors of mortality. CONCLUSIONS: Laparotomy was the most frequent method of treatment (83%). Primary laparotomy and drainage with laparotomy groups had similar mortalities (23-24%), while the drainage alone treatment cohort was associated with the highest mortality (60%) with statistical value (P=0.043). Consequently laparotomy is highly protective in terms of survival rate. Stenosis seemed to be statistically associated with drainage. These findings could discourage the use of peritoneal drainage versus a primary laparotomy whenever the clinical conditions of patients allow this procedure.

AB - BACKGROUND: Necrotizing enterocolitis (NEC) is the most common surgical emergency in newborns and it is still a leading cause of death despite the improvements reached in the management of the critically ill neonate. The purpose of this study was to evaluate risk factors, surgical treatments and outcome of surgical NEC. METHODS: We retrospectively evaluated a multicentric group of 184 patients with surgical NEC over a period of 5 years (2008-2012). Indications to operation were modified NEC Bell stages IIIA or IIIB. The main outcome was measured in terms of survival and postsurgical complications. RESULTS: Data on 184 patients who had a surgical NEC were collected. The majority of patients (153) had a primary laparotomy (83%); 10 patients had peritoneal drainage insertion alone (5%) and 21 patients had peritoneal drainage followed by laparotomy (12%). Overall mortality was 28%. Patients with lower gestational age (P=0.001), lower birth weight (P=0.001), more extensive intestinal involvement (P=0.002) and cardiac diseases (P=0.012) had a significantly higher incidence of mortality. There was no statistically significant association between free abdominal air on the X-ray and mortality (P=0.407). Mortality in the drainage group was 60%, in the laparotomy group and drainage followed by laparotomy group was of 23-24% (P=0.043). There was a high incidence of stenosis (28%) in the drainage group (P=0.002). On multivariable regression, lower birth weight, feeding, bradycardia-desaturation and extent of bowel involvement were independent predictors of mortality. CONCLUSIONS: Laparotomy was the most frequent method of treatment (83%). Primary laparotomy and drainage with laparotomy groups had similar mortalities (23-24%), while the drainage alone treatment cohort was associated with the highest mortality (60%) with statistical value (P=0.043). Consequently laparotomy is highly protective in terms of survival rate. Stenosis seemed to be statistically associated with drainage. These findings could discourage the use of peritoneal drainage versus a primary laparotomy whenever the clinical conditions of patients allow this procedure.

KW - Constriction

KW - Drainage

KW - Enterocolitis

KW - Laparotomy

KW - Mortality

KW - Necrotizing

KW - Pathologic

UR - http://www.scopus.com/inward/record.url?scp=85018862108&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85018862108&partnerID=8YFLogxK

U2 - 10.23736/S0026-4733.17.07159-0

DO - 10.23736/S0026-4733.17.07159-0

M3 - Article

AN - SCOPUS:85018862108

VL - 72

SP - 183

EP - 187

JO - Minerva Chirurgica

JF - Minerva Chirurgica

SN - 0026-4733

IS - 3

ER -