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. 2022 Apr;42(4):440-445.
doi: 10.1038/s41372-021-01191-7. Epub 2021 Aug 28.

Characteristics and outcomes of a multi-institution cohort of infants with necrotizing enterocolitis totalis

Allison T Rose  1 , Isabella Zaniletti  2 , Matthew T Santore  3 , Anthony J Piazza  4
Affiliations

Characteristics and outcomes of a multi-institution cohort of infants with necrotizing enterocolitis totalis

Allison T Rose et al. J Perinatol. 2022 Apr.

Abstract

Objective: To characterize the presentation, management and outcomes of infants with necrotizing enterocolitis totalis (tNEC) vs surgical non-totalis NEC (sNEC).

Study design: This retrospective study identified infants undergoing surgery for NEC through The Children's Hospitals Neonatal Database. Demographic, surgical and mortality characteristics were compared.

Results: Of 1059 infants, 161 (15.2%) had tNEC. Perinatal characteristics did not differ. tNEC infants were older and were less likely to have pneumoperitoneum at referral (5.6% vs 13.1%, p < 0.001) or intestinal perforation at surgery (38.5% vs 66.7%, p < 0.001). Infants with tNEC were more acidotic preoperatively (7.1, [IQR 7, 7.3] vs 7.3, [IQR 7.2, 7.4], p < 0.001). Mortality was 96.9% for tNEC and 26.5% for sNEC (p < 0.001). tNEC cases varied by center, accounting for 0-43% of all surgical NEC cases.

Conclusions: Mortality is high for tNEC infants, who present at older age, with greater illness severity but are less likely to have intestinal perforation than sNEC infants.

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Conflict of interest statement

All listed authors declare no real or perceived conflicts of interest with the exception of Isabella Zaniletti, who is an employee of the Children’s Hospital Association, Inc (Overland Park, KS) which designed, launched and maintained the database used in this study from 2012–2016.

Figures

Fig. 1
Fig. 1. Diagram of study population.
NEC Necrotizing enterocolitis, GI gastrointestinal, sNEC surgical necrotizing enterocolitis, tNEC necrotizing enterocolitis totalis.
Fig. 2
Fig. 2. Kaplan-Meier Survival curves by necrotizing enterocolitis typic.
Time to death is significantly different between tNEC and sNEC infants. (Logrank p < 0.001).
Fig. 3
Fig. 3. Percent overall mortality by center and percent totalis by center for centers contributing at least five patients to the study cohort.
The x axis represents individual CHND centers ordered by percent mortality. Black diamonds represent the percentage of all infants (tNEC + sNEC) who died by center with 95% confidence intervals (95% CI). Black dots represent the percentage of infants with tNEC by center with 95% CI. *Centers whose mortality rate is different than full cohort mortality rate (37.2%, 95% CI 34–40%). †Centers whose totalis rate is different than full cohort totalis rate (15%, 95% CI 13–17%).
See this image and copyright information in PMC

References

    1. Jacob J, Kamitsuka M, Clark RH, Kelleher AS, Spitzer AR. Etiologies of NICU deaths. Pediatrics. 2015;135:e59–65. doi: 10.1542/peds.2014-2967. - DOI - PubMed
    1. Dukleska K, Devin CL, Martin AE, Miller JM, Sullivan KM, Levy C, et al. Necrotizing enterocolitis totalis: high mortality in the absence of an aggressive surgical approach. Surgery. 2019;165:1176–81. doi: 10.1016/j.surg.2019.03.005. - DOI - PubMed
    1. Murthy K, Yanowitz TD, DiGeronimo R, Dykes FD, Zaniletti I, Sharma J, et al. Short-term outcomes for preterm infants with surgical necrotizing enterocolitis. J Perinatol. 2014;34:736–40. doi: 10.1038/jp.2014.153. - DOI - PubMed
    1. Voss M, Moore SW, van der Merwe I, Pieper C. Fulminanting necrotising enterocolitis: outcome and prognostic factors. Pediatr Surg Int. 1998;13:576–80. doi: 10.1007/s003830050407. - DOI - PubMed
    1. Clark RH, Gordon P, Walker WM, Laughon M, Smith PB, Spitzer AR. Characteristics of patients who die of necrotizing enterocolitis. J Perinatol. 2012;32:199–204. doi: 10.1038/jp.2011.65. - DOI - PMC - PubMed

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