Share on facebook
Share on twitter
Share on linkedin

Outcomes Of Surgical Necrotising Enterocolitis: Is It Time To Review The Rule Of Thirds?

Shazia P Sharif1, Bethan Johnson1, Rafdzah A. Zaki2, Michael F. Hird1, Simon R. Phelps1


1. The Royal London Children’s Hospital, London, UK . 2. Faculty of Medicine, University of Malaya, Malaysia.

Introduction (include hypothesis)

Necrotising enterocolitis (NEC) is the commonest surgical gastrointestinal condition affecting premature infants. It still carries a significant morbidity and mortality despite advances in neonatal intensive care. The BAPS-CASS NEC group reaffirmed traditional surgical teaching that a third of infants undergoing surgery for NEC will die. Accurate unit-specific outcome data is essential for informed parent counselling and to guide expectations regarding likely outcomes in infants with NEC.

Methods (include source of funding and ethical approval if required)

A retrospective study was undertaken of a prospectively collected electronic database (Badgernet) of all consecutive neonates with NEC stage 2 and 3 in a 10 year period (2009-2018).

Data on patient demographics, clinical parameters, abdominal radiographs, surgical status, discharge from the neonatal unit and death were recorded.

Statistical analysis was performed using SPSS.


There were 215 patients: 119 male (55%) and 96 (45%) female.191 (89%) had NEC stage 2 and the remaining 24 (11%) had NEC stage 3.107 (49.8%) patients had surgery for NEC and the remaining 108 (50.2%) were treated medically.

Outcome following admission to NICU and treatment for NEC: 167 (78%) were discharged home from NICU, 16 (7%) discharged to other specialist units for specialist care (gastroenterology, hepatobiliary, respiratory). 32 (15%) patients died. This highlights the need for appropriate clinical pathways for transition to paediatric subspecialty care.

There was no significant difference in mortality rates between the years over the decade. Risk factors that were statistically significantly associated with mortality were: gestation <28 weeks (p=0.002): extremely LBW <1000g (p<0.001); surgical intervention (p<0.001) with a mortality rate of 26% of those undergoing a surgical procedure.


Our mortality rate of 15% in infants with NEC; and a 26% mortality rate for infants undergoing surgery show an improvement in comparison to the national BAPS-CASS study. It is difficult to attribute specific care factors to this but a commitment to combined joint senior neonatology/surgery review is vital to timely decision making.

References (include acknowledgement here if appropriate)

One-year outcomes following surgery for necrotising enterocolitis: a UK-wide cohort study.

Allin BSR, et al. Arch Dis Child Fetal Neonatal Ed. 2018;103:F461-F466.

More to explorer

Spring Meeting 2023

10th March 2023 The Royal Society of Medicine, London​ 09.30 – 18.00 GMT Register Here Submit Abstract Submission deadline for Spring Meeting

Autumn Meeting 2022

10th November 2022 Hybrid event: in person and online meeting at the Royal Society of Medicine, London Includes the Annual General Meeting

Summer Meeting 2022

23 – 24th June 2022 University of Winchester Register Here Submit Abstract Submission deadline 5 pm on 22nd May 2022. KEY LECTURES

Search by category
Scroll to Top

We use cookies to improve your experience on our website. By browsing this website, you agree to our use of cookies.