C. M. Lamoutte1, D. M. De La Cruz2, F. O. Badru1, D. Neal1, J. A. Taylor1 1University Of Florida, Department Of Surgery, Gainesville, FL, USA 2University Of Florida, Department Of Pediatrics, Gainesville, FL, USA
Introduction: Necrotizing enterocolitis (NEC) is a devastating disease of prematurity that leads to surgical intervention in about 30% of patients. While abdominal distention alone is not an indication for surgical intervention, its trend, measured via abdominal circumference, can be a helpful adjunct in decision-making. There is currently no defined increase in abdominal circumference that predicts need for surgery. The aim of this study was to define the relationship, if any, between change in abdominal girth and need for surgical intervention for NEC.
Methods: An IRB-exempt retrospective chart review of NICU patients from 2015-2020 at a single institution was performed. Patients were identified using ICD-10 code for NEC. Inclusion criteria were gestational age (GA) < 37 weeks and confirmed pneumatosis and/or portal venous gas on x-ray. Exclusion criteria were multiple NEC episodes during admission, major congenital anomalies, and outborn patients transferred for NEC. Demographic data, daily largest abdominal girth, and routine laboratory data were recorded for every day of the patients’ NEC treatment. Average daily percent change in abdominal girth was calculated. Largest percent change from the first abdominal girth of NEC episode was calculated as well as the number of days between day 1 and the day of largest percent change. Statistical analysis was performed using Mann-Whitney U tests (p<0.05).
Results: Of 178 identified patients, 43 were included in the final analysis. 30 (70%) were medically managed and 13 (30%) underwent surgical intervention. There was a statistically significant difference in the average daily percent change in abdominal girth between the medical and surgical patients in the <30 week GA and the >30 week GA group; this significance persisted when analyzing the patients based on <1000g and >1000g birth weight. There was a statistically significant difference in overall largest percent change from the first abdominal girth measurement in both GA groups. Regarding threshold of girth increase predictive of needing surgical intervention, there was no significance found. Laboratory data analysis did not yield any correlations. Further subgrouping by GA and weight did not yield sample sizes large enough for appropriate statistical analysis.
Conclusion: Changes in abdominal girth differ significantly between medical NEC and surgical NEC cases. This study was limited by small sample size, particularly when attempting subgroup analysis. Establishing a threshold for percent change in abdominal girth would be valuable for NEC management protocols, regarding decision-making for timing of surgical intervention. While this could not be determined within this patient sample, any increase in girth put the patient at risk for needing surgery. Based on this, following abdominal girths should continue to be a data point included in the medical management and surgical decision-making for premature infants with NEC.