Outcome of NEC and FIP: Surgical Treatment or Wait and See?

Background: Necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) affect almost exclusively premature new-borns. Incidence of NEC is 0.3% and rises up to 15% in birth weight

Objective: Aim of this study is to evaluate surgery rate, complications, clinical outcome and hospital stay after NEC and FIP.

Methods: Seventy-six children treated for NEC or FIP during study period (2003-2013) were included in 3 groups: Group 1: NEC without perforation, group 2: FIP, and group 3: NEC and perforation. All data recorded during hospital stay till discharge including surgical procedures were collected.

Results: In group 1, 44% underwent surgery, in group 2 and 3, 100% were surgically treated. Complications like hematocrit decrease occur in 36.1%, and in 57.4% of these children blood transfusions were necessary: group 3 was affected in 62.2%, followed by group 2 and 1 in 50% each. Postsurgical bleeding or perforation occurred in group 1 and 3. Post-surgical short bowel syndrome (9,8%) and malnutrition (6,6%) were present in group 1 and 3. Cholestasis was present in 41% of all children; in 45.9% of group 3, in 41.7% of group 2 and in 25% of group 1. Complications like stoma prolapse was present in group 2 (58,3%) and in group 3 (33.3%). The hospital duration stay differs, in group 1 the average stay was 85,4 days, in group 2, 111,1 days and in group 3, 114,1 days.

Conclusion: NEC with perforation was treated surgical more frequently, experienced significantly higher levels of complications and had extended hospital stay, followed by FIP and at least by NEC without perforation. Post-operative complications and length of stay correlate with the children`s outcome. To optimize clinical outcome recognition of NEK is necessary before occurrence of gut perforation.