Trends in incidence and outcomes of necrotizing enterocolitis over the last 12 years: A multicenter cohort analysis

Sam M Han; Charles R Hong; Jamie Knell; Erika M Edwards; Kate A Morrow; Roger F Soll; Biren P Modi; Jeffrey D Horbar; Tom Jaksic

doi:10.1016/j.jpedsurg.2020.02.046

Trends in incidence and outcomes of necrotizing enterocolitis over the last 12 years: A multicenter cohort analysis

J Pediatr Surg. 2020 Jun;55(6):998-1001. doi: 10.1016/j.jpedsurg.2020.02.046. Epub 2020 Feb 29.

Authors

Sam M Han¹, Charles R Hong¹, Jamie Knell¹, Erika M Edwards², Kate A Morrow³, Roger F Soll², Biren P Modi¹, Jeffrey D Horbar², Tom Jaksic⁴

Affiliations

¹ Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
² University of Vermont and Vermont Oxford Network, Burlington, VT, USA.
³ Vermont Oxford Network, Burlington, VT, USA.
⁴ Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: tom.jaksic@childrens.harvard.edu.

PMID: 32173122
DOI: 10.1016/j.jpedsurg.2020.02.046

Abstract

Objective: We sought to describe changes in the incidence and mortality of necrotizing enterocolitis (NEC) and associated surgical management strategies for very low birth weight (VLBW) infants.

Methods: Data were prospectively collected on VLBW infants (≤1500 g or < 29 weeks) born 2006 to 2017 and admitted to 820 U.S. centers. NEC was defined by the presence of at least one clinical and one radiographic finding. Trends analyses were performed to assess changes in incidence and mortality over time.

Results: Of 473,895 VLBW infants, 36,130 (7.6%) were diagnosed with NEC, of which 21,051 (58.3%) had medical NEC and 15,079 (41.7%) had surgical NEC. Medical NEC decreased from 5.3% to 3.0% (p < 0.0001). Surgical NEC decreased from 3.4% to 3.1% (p = 0.06). Medical NEC mortality decreased from 20.7% to 16.8% (p = 0.003), while surgical NEC mortality decreased from 36.6% to 31.6% (p < 0.0001). In the surgical cohort, the use of primary peritoneal drainage (PPD) versus initial laparotomy rose from 23.2% to 46.8%.

Conclusion: The incidence and mortality of both medical and surgical NEC have decreased over time. Changes in surgical management during this time period included the increased utilization of primary peritoneal drainage.

Type of study: Prognosis study.

Level of evidence: Level II.

Keywords: Infant; NICU; Necrotizing enterocolitis; Prematurity; Primary peritoneal drainage.

Publication types

Multicenter Study

MeSH terms

Enterocolitis, Necrotizing* / epidemiology
Enterocolitis, Necrotizing* / mortality
Enterocolitis, Necrotizing* / therapy
Female
Humans
Infant, Newborn
Infant, Newborn, Diseases* / epidemiology
Infant, Newborn, Diseases* / mortality
Infant, Newborn, Diseases* / therapy
Infant, Very Low Birth Weight
Male
Prospective Studies
Treatment Outcome