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Necrotising Enterocolitis that requires surgery has a significant impact on survival

Presented at the Neonatal Society 2011 Spring Meeting.

Cleeve S, Ward H, Hird, M

Barts and The London NHS Trust, London, UK

Background: Surgery for necrotising enterocolitis (NEC) is most often undertaken when the clinical condition is failing to stabilise despite maximal medical management. This study explores the impact that NEC, severe enough to require surgery, has on survival.

Methods: Prospectively maintained neonatal medical and surgical databases were used to collect information regarding all admissions over two similiar periods. Data was collected regarding gestational age (GA), surgery and survival. Data regarding neonates requiring surgery for NEC was collected in the period 2006 to 2010 and compared to the most recent survival data for our unit, the period 2007 to 2010.

Results: In the NEC study period there were 2926 admissions, 15.8% (461/2926) were diagnosed with NEC or suspected NEC and 3.5% (103/2926) had surgery for NEC. Expected survival was drawn from admission 2007 to 2010. The table compares survival relative to gestational age (weeks):

Necrotising Enterocolitis that requires surgery has a significant impact on survival

Overall survival for neonates operated on for NEC was 68% (70/103). Overall expected survival was 93% (1588/1669). Chi-square testing demonstrated a significant decrease in survival as shown in table. Neonates who require surgery for NEC have decreased survival compared to neonates of similar gestational age and this effect becomes more significant as gestational age increases.

Conclusion: Neonates that develop NEC that is severe enough to require surgery have decreased survival, which becomes more significant as gestational age increases. This phenomenon remains unexplained and requires further investigation.

Corresponding author: stewart.cleeve@bartsandthelondon.nhs.uk

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