Does Surgical Management Alter Outcome in Necrotizing Enterocolitis?

Benjamin D Carr; Samir K Gadepalli

doi:10.1016/j.clp.2018.09.008

Does Surgical Management Alter Outcome in Necrotizing Enterocolitis?

Clin Perinatol. 2019 Mar;46(1):89-100. doi: 10.1016/j.clp.2018.09.008. Epub 2018 Dec 12.

Authors

Benjamin D Carr¹, Samir K Gadepalli²

Affiliations

¹ Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, 1540 East Hospital Drive, SPC 4211, Ann Arbor, MI 48108, USA.
² Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, 1540 East Hospital Drive, SPC 4211, Ann Arbor, MI 48108, USA. Electronic address: samirg@med.umich.edu.

PMID: 30771822
DOI: 10.1016/j.clp.2018.09.008

Abstract

Necrotizing enterocolitis occurs in 14% of infants less than 1000 g. Preoperative management varies widely, and the only absolute indication for surgery is pneumoperitoneum. Multiple biomarkers and scoring systems are under investigation, but clinical practice is still largely driven by surgeon judgment. Outcomes in panintestinal disease are poor, and multiple creative approaches are used to preserve bowel length. Overall, recovery is complicated in the short and long term. Major sequelae are stricture, short gut syndrome, and neurodevelopmental impairment. Resolving controversies in surgical necrotizing enterocolitis care requires multicenter collaboration for centralized data and tissue repositories, benchmarking, and carrying out prospective randomized controlled trials.

Keywords: Complications; Enterostomy; Laparotomy; Metabolic derangement; Necrotizing enterocolitis; Peritoneal drainage; Primary anastomosis; Surgery.

Publication types

Review

MeSH terms

Anastomosis, Surgical
Digestive System Surgical Procedures / methods*
Drainage / methods
Enterocolitis, Necrotizing / surgery*
Enterostomy / methods
Humans
Infant, Newborn
Infant, Premature
Laparotomy / methods
Patient Selection*
Time Factors