Neonatal necrotizing entero-colitis: A clinico-surgical study
Necrotizing enterocolitis (NEC) is most common gastrointestinal emergency among neonates admitted to the intensive care units. Aim of this study is to assess incidence, management, outcome and prognostic factors favouring survival of NEC cases. Methods: A prospective study on 52 cases, age between 1...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2013-12-01
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| Series: | African Journal of Emergency Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211419X13001559 |
| _version_ | 1818159232514523136 |
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| author | A.I. Eid* M.I. El-Sawaf H. Dawoud M.A. Rowisha |
| author_facet | A.I. Eid* M.I. El-Sawaf H. Dawoud M.A. Rowisha |
| author_sort | A.I. Eid* |
| collection | DOAJ |
| description | Necrotizing enterocolitis (NEC) is most common gastrointestinal emergency among neonates admitted to the intensive care units. Aim of this study is to assess incidence, management, outcome and prognostic factors favouring survival of NEC cases.
Methods: A prospective study on 52 cases, age between 1 and 30 days (11 full-term and 41 preterm) with NEC among neonatal intensive care unit (NICU) admissions. According to modified Bell’s classification, cases were classified into 3 groups (stage I, 12), (stage II, 20) and (stage III, 20). Stages I and II treated medically, while stage III treated surgically (peritoneal drainage and/or laparotomy). All results were statistically analysed using chi-square and ANOVA tests by SPSS, v16.
Results: Incidence of NEC in our study was 8.5% with mean presenting age (8.9 days), mean birth-weight (2200 grams) and mean gestational-age (34.9 weeks). The commonest presenting feature was abdominal distension (82.7%), followed by respiratory distress (76.9%) and neonatal sepsis (61.5%). Thrombocytopenia and hyponatraemia were present in all cases, metabolic-acidosis in 92.3% and CRP was positive in 78.9%. Free fluid was present in 73.1%, pneumo-peritoneum in 38.5% and pneumatosis-intestinalis in 15.4%. Medical treatment was sufficient in 20 out of 32 cases of stage I and II (62.5% survival). Between the 20 cases of stage III; 6 cases subjected to immediate Laparotomy (33.3% survival), 14 cases treated with peritoneal drainage, 4 survived, 2 cases were in need for subsequent laparotomy and survived. Stoma formation was done in 4 cases; resection with primary anastomosis was done in 1 case while primary repair was done in 3 cases. The overall survival in the study was 53.85%.
Conclusion: Early diagnosis and intensive medical and surgical treatment were mandatory to minimize both morbidity and mortality from NEC. Surgical management should be determined according to the special circumstances of each case. However, the optimum choice between peritoneal drainage and laparotomy remains controversial. Gestational age, birth weight, age at admission, and treatment modality are definite prognostic factors as regard morbidity and mortality of patients with NEC. |
| first_indexed | 2024-12-11T15:42:43Z |
| format | Article |
| id | doaj.art-d44cb3066a5a44628f5f4fc3e8804981 |
| institution | Directory Open Access Journal |
| issn | 2211-419X |
| language | English |
| last_indexed | 2024-12-11T15:42:43Z |
| publishDate | 2013-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | African Journal of Emergency Medicine |
| spelling | doaj.art-d44cb3066a5a44628f5f4fc3e88049812022-12-22T00:59:47ZengElsevierAfrican Journal of Emergency Medicine2211-419X2013-12-0134S13S1410.1016/j.afjem.2013.08.034Neonatal necrotizing entero-colitis: A clinico-surgical studyA.I. Eid*M.I. El-SawafH. DawoudM.A. RowishaNecrotizing enterocolitis (NEC) is most common gastrointestinal emergency among neonates admitted to the intensive care units. Aim of this study is to assess incidence, management, outcome and prognostic factors favouring survival of NEC cases. Methods: A prospective study on 52 cases, age between 1 and 30 days (11 full-term and 41 preterm) with NEC among neonatal intensive care unit (NICU) admissions. According to modified Bell’s classification, cases were classified into 3 groups (stage I, 12), (stage II, 20) and (stage III, 20). Stages I and II treated medically, while stage III treated surgically (peritoneal drainage and/or laparotomy). All results were statistically analysed using chi-square and ANOVA tests by SPSS, v16. Results: Incidence of NEC in our study was 8.5% with mean presenting age (8.9 days), mean birth-weight (2200 grams) and mean gestational-age (34.9 weeks). The commonest presenting feature was abdominal distension (82.7%), followed by respiratory distress (76.9%) and neonatal sepsis (61.5%). Thrombocytopenia and hyponatraemia were present in all cases, metabolic-acidosis in 92.3% and CRP was positive in 78.9%. Free fluid was present in 73.1%, pneumo-peritoneum in 38.5% and pneumatosis-intestinalis in 15.4%. Medical treatment was sufficient in 20 out of 32 cases of stage I and II (62.5% survival). Between the 20 cases of stage III; 6 cases subjected to immediate Laparotomy (33.3% survival), 14 cases treated with peritoneal drainage, 4 survived, 2 cases were in need for subsequent laparotomy and survived. Stoma formation was done in 4 cases; resection with primary anastomosis was done in 1 case while primary repair was done in 3 cases. The overall survival in the study was 53.85%. Conclusion: Early diagnosis and intensive medical and surgical treatment were mandatory to minimize both morbidity and mortality from NEC. Surgical management should be determined according to the special circumstances of each case. However, the optimum choice between peritoneal drainage and laparotomy remains controversial. Gestational age, birth weight, age at admission, and treatment modality are definite prognostic factors as regard morbidity and mortality of patients with NEC.http://www.sciencedirect.com/science/article/pii/S2211419X13001559 |
| spellingShingle | A.I. Eid* M.I. El-Sawaf H. Dawoud M.A. Rowisha Neonatal necrotizing entero-colitis: A clinico-surgical study African Journal of Emergency Medicine |
| title | Neonatal necrotizing entero-colitis: A clinico-surgical study |
| title_full | Neonatal necrotizing entero-colitis: A clinico-surgical study |
| title_fullStr | Neonatal necrotizing entero-colitis: A clinico-surgical study |
| title_full_unstemmed | Neonatal necrotizing entero-colitis: A clinico-surgical study |
| title_short | Neonatal necrotizing entero-colitis: A clinico-surgical study |
| title_sort | neonatal necrotizing entero colitis a clinico surgical study |
| url | http://www.sciencedirect.com/science/article/pii/S2211419X13001559 |
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