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© 2015 Annals of Pediatric Surgery. Introduction: Necrotizing enterocolitis (NEC) is a serious gastrointestinal emergency in newborn infants. Surgical management includes primary peritoneal drainage and/or exploratory laparotomy with bowel resection. This study describes obstetric complications, postnatal comorbidities, surgical care and intermediate postoperative outcomes in all infants with surgically and/or histologically proven NEC, who underwent exploratory laparotomy at our tertiary referral centre. Materials and methods: We conducted a retrospective review between January 2005 and December 2010. Results are reported as median (range). Fisher's exact test (two tailed) was used for statistical analysis. A P-value of 0.05 or less was considered statistically significant. Results: A total of 71 infants had suspected (Bell's stage ≥ 1) NEC. Of them, 32 infants underwent laparotomy for stage 2-3 NEC. We excluded 11 infants with surgically and/or histologically proven spontaneous intestinal perforation. In the remaining 21 infants with confirmed NEC, median gestational age was 27 weeks (23-39 weeks) and median birth weight was 720 g (440-3510 g). NEC was suspected after a median 14 days of life (1-49 days of life). Fifteen patients (71%) were initially managed medically for a median total of 8 days (1-25 days). Laparotomy was performed after a median of 7 days (<1-35 days) from the suspicion of NEC. Eleven infants (52%) underwent bowel resection and enterostomy, four infants (19%) underwent bowel resection with primary anastomosis and one infant (5%) underwent proximal diverting jejunostomy. Bowel perforation was seen in seven patients (33%). Necrosis totalis was evident in five patients (24%). There were 12 postoperative deaths (57% mortality), and seven deaths (58%) occurred during the first 30 days. Infants who died were more likely to have had absent/reversed enddiastolic flow (n=5, P= 0.64), intrauterine growth retardation (n=5, P = 0.18) or a gestational birth weight between 501 and 750 g (n=9, P = 0.08). In the surviving children (n= 9), the median length of hospital stay was 134 days (87-190 days) and postoperative sequelae were frequently seen. Conclusion: The morbidity and mortality for infants with confirmed NEC who undergo laparotomy remain high in infants despite optimal medical and surgical care.

Original publication




Journal article


Annals of Pediatric Surgery

Publication Date





123 - 126