Advanced necrotizing enterocolitis part 1: mortality

Eur J Pediatr Surg. 2012 Feb;22(1):8-12. doi: 10.1055/s-0032-1306263. Epub 2012 Mar 20.


Aim of the study: The aim of this study was to investigate the factors associated with mortality in infants referred for the surgical treatment of advanced necrotizing enterocolitis (NEC).

Methods: Retrospective review of all infants with confirmed (Bell stage II or III) NEC treated in our unit during the past 8 years (January 2002 to December 2010). Data for survivors and nonsurvivors were compared using Mann-Whitney test and Fisher's exact test and are reported as median (range).

Results: Of the 205 infants with NEC, 35 (17%) were medically managed; 170 (83%) had surgery; 66 (32%) infants died; all had received surgery. Survivors and nonsurvivors were comparable for gestational age, birth weight, and gender distribution. Overall mortality was 32%, the highest mortality was in infants with pan-intestinal disease (86%) but remained significant in those with less severe disease (multifocal 39%; focal disease 21%). The commonest cause of mortality was multiple organ dysfunction syndrome and nearly half of the nonsurvivors had care withdrawn.

Conclusion: Despite improvement in neonatal care, overall mortality (32%) for advanced NEC has not changed in 10 years. Mortality is significant even with minimal bowel involvement.

MeSH terms

  • Causality
  • Cause of Death
  • Enterocolitis, Necrotizing / mortality*
  • Enterocolitis, Necrotizing / surgery
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Multiple Organ Failure / mortality*
  • Regression Analysis
  • Retrospective Studies
  • Survival Rate