Predictive factors related to surgical decision-making in neonates with necrotizing enterocolitis
Keywords:Necrotizing Enterocolitis, C-Reactive Protein, Neonate
BACKGROUND: Necrotizing enterocolitis (NEC) is more common in neonates. This study aimed to determine the predictive factors in the decision-making about surgery in neonates with NEC.
METHODS: This retrospective cohort study was performed in Ali Asghar Children's Hospital in Tehran, Iran. All neonates hospitalized due to NEC from 2018 to 2020 were enrolled in this study. We compared the study variables such as demographic, clinical, laboratory, radiography, and sonography variables in neonates who underwent surgery with neonates without surgery. Statistical analysis was conducted by SPSS and R software.
RESULTS: There was no statistically significant difference between the two groups regarding age at hospitalization, sex, gestational age, and birth weight (P > 0.05). Comparison of laboratory, clinical, and radiography findings showed that there were significant statistical differences in terms of C-reactive protein (CRP), prothrombin time (PT), international normalized ratio (INR), sodium (Na), procalcitonin (PCT), skin discoloration of the abdominal wall, presence of portal venous gas (PVG), pneumoperitoneum, ascites, and fixed intestinal loop between two groups (P < 0.05). The results also showed that presence of skin discoloration of the abdominal wall, high level of CRP, PVG, pneumoperitoneum, ascites, and fixed intestinal loop were predictive factors for the decision of surgery.
CONCLUSION: The abdominal color change, high level of CRP, PVG, pneumoperitoneum, ascites, and fixed intestinal loop are predictive factors for the decision of surgery in neonates with NEC.
Bellodas SJ, Kadrofske M. Necrotizing enterocolitis. Neurogastroenterol Motil. 2019; 31(3): e13569.
Doheny KK, Palmer C, Browning KN, Jairath P, Liao D, He F, et al. Diminished vagal tone is a predictive biomarker of necrotizing enterocolitis-risk in preterm infants. Neurogastroenterol Motil. 2014; 26(6): 832-40.
Boghossian NS, Geraci M, Edwards EM, Horbar JD. Sex differences in mortality and morbidity of infants born at less than 30 weeks' gestation. Pediatrics. 2018; 142(6).
Beltempo M, Shah PS, Ye XY, Afifi J, Lee S, McMillan DD. SNAP-II for prediction of mortality and morbidity in extremely preterm infants. J Matern Fetal Neonatal Med. 2019; 32(16): 2694-701.
Suzuki Y, Kono Y, Hayakawa T, Shimozawa H, Matano M, Yada Y. Neonatal factors related to center variation in the incidence of late-onset circulatory collapse in extremely preterm infants. PLoS One. 2018; 13(6): e0198518.
Persson M, Shah PS, Rusconi F, Reichman B, Modi N, Kusuda S, et al. Association of maternal diabetes with neonatal outcomes of very preterm and very low-birth-weight infants: An international cohort study. JAMA Pediatr. 2018; 172(9): 867-75.
Alsaied A, Islam N, Thalib L. Global incidence of Necrotizing Enterocolitis: A systematic review and Meta-analysis. BMC Pediatr. 2020; 20(1): 344.
Alganabi M, Lee C, Bindi E, Li B, Pierro A. Recent advances in understanding necrotizing enterocolitis. F1000Res. 2019; 8: F1000.
Wang K, Tao G, Sun Z, Sylvester KG. Recent potential noninvasive biomarkers in necrotizing enterocolitis. Gastroenterol Res Pract. 2019; 2019: 8413698.
Niemarkt HJ, de Meij TG, van de Velde ME, van der Schee MP, van Goudoever JB, Kramer BW, et al. Necrotizing enterocolitis: A clinical review on diagnostic biomarkers and the role of the intestinal microbiota. Inflamm Bowel Dis. 2015; 21(2): 436-44.
Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011; 364(3): 255-64.
Ganji N, Li B, Lee C, Filler R, Pierro A. Necrotizing enterocolitis: State of the art in translating experimental research to the bedside. Eur J Pediatr Surg. 2019; 29(4): 352-60.
Dominguez KM, Moss RL. Necrotizing enterocolitis. Clin Perinatol. 2012; 39(2): 387-401.
Nino DF, Sodhi CP, Hackam DJ. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Nat Rev Gastroenterol Hepatol. 2016; 13(10): 590-600.
Argumosa Salazar Y, Fernandez Cordoba MS, Gonzalvez PJ, Hernandez AE, Baquero CM, Medina MC, et al. Necrotizing entercolitis and intestinal perforation in very low weight premature infants: which is the best surgical option?. Cir Pediatr. 2011; 24(3): 142-5.
Ehrlich PF, Sato TT, Short BL, Hartman GE. Outcome of perforated necrotizing enterocolitis in the very low-birth weight neonate may be independent of the type of surgical treatment. Am Surg. 2001; 67(8): 752-6.
Parikh M, Samujh R, Kanojia RP, Rao KL. Decision-making in surgical neonatal necrotizing enterocolitis. J Indian Assoc Pediatr Surg. 2009; 14(3): 102-7.
Muchantef K, Epelman M, Darge K, Kirpalani H, Laje P, Anupindi SA. Sonographic and radiographic imaging features of the neonate with necrotizing enterocolitis: correlating findings with outcomes. Pediatr Radiol. 2013; 43(11): 1444-52.
Knudsen KBK, Thorup J, Thymann T, Strandby R, Nerup N, Achiam MP, et al. Laparoscopy to Assist Surgical Decisions Related to Necrotizing Enterocolitis in Preterm Neonates. J Laparoendosc Adv Surg Tech A. 2020; 30(1): 64-9.
Tam AL, Camberos A, Applebaum H. Surgical decision making in necrotizing enterocolitis and focal intestinal perforation: Predictive value of radiologic findings. J Pediatr Surg. 2002; 37(12): 1688-91.
Sharma R, Tepas JJ 3rd, Hudak ML, Wludyka PS, Mollitt DL, Garrison RD, et al. Portal venous gas and surgical outcome of neonatal necrotizing enterocolitis. J Pediatr Surg. 2005; 40(2): 371-6.
Srinivasjois R, Nathan E, Doherty D, Patole S. Prediction of progression of definite necrotising enterocolitis to need for surgery or death in preterm neonates. J Matern Fetal Neonatal Med. 2010; 23(7): 695-700.
Duci M, Fascetti-Leon F, Erculiani M, Priante E, Cavicchiolo ME, Verlato G, et al. Neonatal independent predictors of severe NEC. Pediatr Surg Int. 2018; 34(6): 663-9.
Silva CT, Daneman A, Navarro OM, Moore AM, Moineddin R, Gerstle JT, et al. Correlation of sonographic findings and outcome in necrotizing enterocolitis. Pediatr Radiol. 2007; 37(3): 274-82.
Epelman M, Daneman A, Navarro OM, Morag I, Moore AM, Kim JH, et al. Necrotizing enterocolitis: review of state-of-the-art imaging findings with pathologic correlation. Radiographics. 2007; 27(2): 285-305.