Feasibility of open abdomen surgery treatment for near fatal necrotizing enterocolitis in preterm infants

Sabine Irtan; Pierre-Louis Reignier; Amélie Durandy; Erik Hervieux; Isabelle Constant; Julie Lemale; Yohan Soreze; Pierre-Louis Leger; Georges Audry; Jérôme Rambaud; Isabelle Guellec

doi:10.1016/j.jpedsurg.2021.09.044

Feasibility of open abdomen surgery treatment for near fatal necrotizing enterocolitis in preterm infants

J Pediatr Surg. 2022 Jul;57(7):1336-1341. doi: 10.1016/j.jpedsurg.2021.09.044. Epub 2021 Oct 2.

Authors

Affiliations

¹ Department of Visceral and Neonatal Pediatric Surgery, Sorbonne University, Armand Trousseau University Hospital, APHP.6, Paris, France.
² Neonatal Intensive Care Unit, CH Poissy Saint-Germain-en-Laye, Poissy, France.
³ Department of Anesthesiology and Intensive Care, Sorbonne University, Armand Trousseau University Hospital, GRC 29, APHP.6, Paris, France.
⁴ Nutrition and Gastroenteterology, Pediatric Department, Sorbonne University, Armand Trousseau University Hospital, APHP.6, France.
⁵ Neonatal and Pediatric Care Unit, Sorbonne University, Armand Trousseau University Hospital, AP-HP.6, Paris, France.
⁶ Neonatal and Pediatric Care Unit, Sorbonne University, Armand Trousseau University Hospital, AP-HP.6, Paris, France. Electronic address: isabelle.guellec@inserm.fr.

PMID: 34696919
DOI: 10.1016/j.jpedsurg.2021.09.044

Abstract

Introduction: Necrotizing Enterocolitis (NEC) remained a dramatic complication leading to death or neonatal morbidities in preterms. For some, Intra-Abdominal Hypertension (IAH) and Abdominal Compartment Syndrome worsened the multi-organ failure. An open abdomen surgery could be an alternative to conventional surgical treatment to move beyond this stage.

Objectives: To retrospectively describe the clinical course, pre- and post-operative features of preterms suffering from severe NEC with IAH treated by open abdomen surgery and referred to our center from October 2007 to September 2019. Our secondary objective is to identify various risk factors for mortality in this population.

Methods: Data on neonatal, clinical, biological, pre and post-operative features and outcome were collected. Univariate analyses were performed to compare their pre and post-operative features stratifying on outcome.

Results: Among 29 included patients, 14 (48%) survived to discharge without short bowel syndrome. Death was associated with an earlier postnatal age at NEC (16.3 ± 9.1 versus 31.3 ± 25.9 days; p = 0.004) and followed a withdrawal of treatment in 60% of cases. Surgery was associated with a significant improvement of respiratory and hemodynamic features (decrease of mean ventilator pressure from 13.1 ± 5.4 to 11.3 ± 4.0 cmH2O, p < 0.001), oxygen requirement (mean FiO2 decreased from 65.0% ± 31.2 to 49.0% ± 24.6, p < 0.001) and inotropic score (from 38.6 ± 70.1 to 29.9 ± 64.3, p < 0.001). In the survival group, pre and post-operative findings exhibited a significant increase of serum lactate concentrations from 2.7 ± 1.6 to 11.0 ± 20.3 mmol/L (p = 0.02) but a similar pH.

Conclusion: Open abdomen surgery could be considered to rescue preterms with near fatal NEC. IAH and Abdominal Compartment Syndrome in these preterms should be investigated through further studies.

Level of evidence: Level III.

Keywords: Intra-abdominal hypertension; Necrotizing enterocolitis; Open abdomen surgery; Preterm.

MeSH terms

Abdomen
Enterocolitis, Necrotizing*
Feasibility Studies
Humans
Infant
Infant, Newborn
Infant, Newborn, Diseases*
Infant, Premature
Intra-Abdominal Hypertension* / etiology
Intra-Abdominal Hypertension* / surgery
Retrospective Studies