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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.

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