Necrotizing enterocolitis with extensive intestinal involvement: A strategy for intestinal length preservation
Year: 2025
Type: article
Study design: Observational Study
Abstract: Introduction Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in the neonatal period and is associated with high morbidity, mortality and intestinal insufficiency. We describe the experience of surgical management of NEC patients with extensive bowel involvement without bowel resection at initial surgery. Materials and methods Retrospective review of neonates with surgical NEC. Patients with involvement of >50 % of the small bowel and/or >50 % of the colon were included. Only a proximal enterostomy without intestinal resection was performed. Patients were divided according to survival and then compared. The software R 4.2.3 (R Core Team, 2023) was used. A p-value of <0.05 was considered statistically significant. Results 33 patients were included. Only the presence of heart disease was significantly associated with mortality. Bowel reconstruction was performed in 17 patients. During reconstruction surgery, enterostomy closure was performed in 11 (64.7 %) cases, segmental resection in 5 patients (29.4 %) and total colectomy in 1. There was a significant difference in the length of the affected bowel between the initial and reconstruction surgery ( p = < 0.0001). Mortality associated with the NEC episode was 36.4 % and 54.5 % overall. The 15 survivors who underwent intestinal reconstruction received their entire nutritional support by the enteral route. Conclusion In neonates with NEC and extensive intestinal involvement, proximal enterostomy without initial resection is an alternative treatment with comparable mortality to other strategies, allowing recovery of most of the affected bowel and intestinal sufficiency.
Authors: Agostina Fontaine, Carla Sofia Contreras, Celeste Carolina Patiño Gonzalez, Enrique Javier Romero Manteola
Institution: Hospital de Niños de la Santísima Trinidad
Language: English
Topic: Infant Nutrition and Health
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,050
OpenAlex ID: W7110922846