Necrotizing Enterocolitis in 20 822 Infants: Analysis of Medical and Surgical Treatments

Abstract

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency of the neonate. Previous information about this disease has largely been gathered from limited series. We analyzed 13 years of the National Inpatient Sample (NIS) and 3 years of the Kids’ Inpatient Database (KID; 1997, 2000, 2003) to generate the most comprehensive profile of outcomes to date of medically versus surgically treated NEC. We identified 20 822 infants with NEC, of whom 15 419 (74.1%) and 5403 (25.9%) were undergoing medical and surgical management, respectively. Overall, surgical patients had greater length of stay, total hospital charges, and mortality. Among infants dying during admission, there was no significant difference in length of stay or charges between the medical and surgical groups. These findings highlight the need for developing a clinically relevant risk stratification tool to identify NEC patients at high risk for death.

Keywords

necrotizing enterocolitis clinical outcomes medical versus surgical management

References

Kliegman RM , Fanaroff AA Necrotizing enterocolitis. N Engl J Med. 1984 ;310:1093-1103.

Lemons JA , Bauer CR , Oh W. , et al. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1995 through December 1996. NICHD Neonatal Research Network. Pediatrics . 2001;107:E1.

Uauy RD , Fanaroff AA , Korones SB , Phillips EA , Phillips JB , Wright LL Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical correlates. National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr. 1991 ;119:630-638.

Lin PW , Stoll BJ Necrotising enterocolitis. Lancet. 2006;368:1271-1283.

Santulli TV , Schullinger JN , Heird WC , et al. Acute necrotizing enterocolitis in infancy: a review of 64 cases . Pediatrics. 1975;55:376-387.

Gibbs K. , Lin J. , Holzman IR Necrotising enterocolitis: the state of the science. Indian J Pediatr. 2007;74:67-72.

Henry MC , Moss RL Current issues in the management of necrotizing enterocolitis. Semin Perinatol. 2004;28:221-233.

Kennedy KA , Tyson JE , Chamnanvanakij S. Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed low-birth-weight infants. Cochrane Database Syst Rev. 2000;(2):CD001241.

Lin HC , Su BH , Chen AC , et al. Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight infants. Pediatrics . 2005;115:1-4.

10.

Dimmitt RA , Meier AH , Skarsgard ED , Halamek LP , Smith BM , Moss RL Salvage laparotomy for failure of peritoneal drainage in necrotizing enterocolitis in infants with extremely low birth weight. J Pediatr Surg . 2000;35: 856-859.

11.

Ein SH , Marshall DG , Girvan D. Peritoneal drainage under local anesthesia for perforations from necrotizing enterocolitis. J Pediatr Surg. 1977;12:963-967.

12.

Morgan LJ , Shochat SJ , Hartman GE Peritoneal drainage as primary management of perforated NEC in the very low birth weight infant. J Pediatr Surg. 1994;29:310-314.

13.

Moss RL , Dimmitt RA , Barnhart DC , et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med. 2006;354:2225-2234.

14.

Agency for Healthcare Research and Quality. Overview of the National Inpatient Sample (NIS). http://www.hcupus.ahrq.gov/nisoverview.jsp. Updated August 12, 2009. Accessed September 9, 2009.

15.

Agency for Healthcare Research and Quality. www.hcup-us.ahrq.gov/kidoverview.jsp. Updated July 30, 2008. Accessed September 9, 2009.

16.

Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP). http://www.hcup-us.ahrq.gov. Accessed September 9, 2009.

17.

Consumer Price Index, Medical Care. Bureau of Labor Statistics. http://www.bls.gov/cpi/cpi_dr.htm . Accessed September 2009.

18.

Sankaran K. , Puckett B. , Lee DS , et al. Variations in incidence of necrotizing enterocolitis in Canadian neonatal intensive care units. J Pediatr Gastroenterol Nutr. 2004;39: 366-372.

19.

Attridge JT , Clark R. , Walker MW , Gordon PV New insights into spontaneous intestinal perforation using a national data set: (1) SIP is associated with early indomethacin exposure. J Perinatol. 2006;26:93-99.

20.

Blakely ML , Tyson JE , Lally KP , et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age. Pediatrics. 2006;117:e680-e687.

21.

Holman RC , Stoll BJ , Curns AT , Yorita KL , Steiner CA , Schonberger LB Necrotising enterocolitis hospitalisations among neonates in the United States . Paediatr Perinat Epidemiol. 2006;20:498-506.

22.

Bisquera JA , Cooper TR , Berseth CL Impact of necrotizing enterocolitis on length of stay and hospital charges in very low birth weight infants. Pediatrics. 2002;109: 423-428.