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. 2021;26(2):179-186.
doi: 10.5863/1551-6776-26.2.179. Epub 2021 Feb 15.

Evaluation of Time to Resolution of Medical Necrotizing Enterocolitis Using Severity-Guided Management in a Neonatal Intensive Care Unit

Katelyn E Bull, Andrew B Gainey, Christina L Cox, Anna-Kathryn Burch, Martin Durkin, Robert Daniels

Evaluation of Time to Resolution of Medical Necrotizing Enterocolitis Using Severity-Guided Management in a Neonatal Intensive Care Unit

Katelyn E Bull et al. J Pediatr Pharmacol Ther. 2021.

Abstract

Objective: No studies, to our knowledge, have determined the relationship between symptom resolution and timing of antimicrobial discontinuation in necrotizing enterocolitis (NEC). Our study seeks to determine the period to NEC resolution by using severity-guided management, based on surrogate markers used in the diagnosis of NEC.

Methods: This retrospective, observational review included patients in our NICU with NEC from June 1, 2012, to June 1, 2018. Patients were excluded for surgical NEC, a positive blood culture or transfer from an outside institution at the time of NEC, presence of a peritoneal drain, or death prior to NEC resolution. The primary outcome was time to resolution of NEC, measured by return to baseline of surrogate markers used in the diagnosis of NEC.

Results: The median times to resolution in days, based on our institution's NEC severity group, were as follows: mild 3 (range, 1-4); moderate 4 (range, 1-17); severe 9 (range, 5-21). No difference in NEC recurrence was found based on antibiotic duration (OR 0.803; 95% CI, 0.142-4.225).

Conclusions: Time to resolution of NEC differs by severity group, suggesting a need for different treatment durations. Recurrence of NEC did not differ between groups, suggesting that shorter antibiotic durations do not lead to an increased incidence of NEC recurrence. Further exploration of the optimal antimicrobial treatment duration for NEC is warranted.

Keywords: antimicrobial stewardship; necrotizing enterocolitis; neonate.

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Conflict of interest statement

Disclosure. The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript, including equipment, medications, employment, gifts, and honoraria. This work was supported by an institutional internal research grant (Palmetto Health Foundation Grant in Aid). All authors have full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Figures

Figure 1.
Figure 1.
Institutional NEC treatment protocol.*
Figure 2.
Figure 2.
Patient selection.
Figure 3.
Figure 3.
Kaplan-Meir curve for time to resolution by severity of NEC.
Figure 4.
Figure 4.
Antibiotic Agent Used.
See this image and copyright information in PMC

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