C. Chabuz1, S. D. Larson1, J. A. Taylor1, S. Islam1 1University Of Florida,Pediatric Surgery,Gainesville, FL, USA
Objective: Necrotizing enterocolitis (NEC) is the most common condition in neonates that requires surgery. While the mortality in NEC is very high, it is unclear which factors are most responsible for poor outcomes. The purpose of this study was to understand the factors influencing mortality in a large cohort of neonates with NEC.
Methods: Neonates diagnosed with NEC over an 8-year period (2008-2016) at UF Health were selected using ICD 9 and 10 codes. All patients’ charts were reviewed and only those with a definitive diagnosis of NEC that was in the initial NICU stay were included. Data regarding demographics, maternal and gestational history, presentation, lab and radiologic studies, interventions required, surgical management, and outcomes were collected and compiled. The primary outcome variable was mortality, with secondary outcomes of NICU LOS and neurodevelopmental status in survivors. The cohort was divided into those requiring surgical management (drain or laparotomy) vs. those treated medically. Uni- and Multi-variate analysis was carried out and p values of less than 0.05 were considered significant.
Results:
A total of 245 cases of NEC were identified during the study period. Overall, the mean gestational age was 28.6 weeks, average birth weight was 1.21 kg, and mortality rate 16.3%. There were 75 patients who required surgical management, while 170 were treated medically. There was no difference between these two groups for race, gender, APGAR score, hematocrit, or length of stay (see table please). Surgical patients were significantly smaller and lower gestational age, had a lower platelet count and presented more often with distention. Univariate analysis noted a significant 5-fold higher mortality rate. Linear, multivariate regression analysis with mortality as the outcome variable noted that surgical management was not a significant predictor, while gestational age, APGAR score, weight at diagnosis of NEC, vasopressor requirement, and intubation were responsible for mortality.
Conclusions: The higher mortality rate in neonates with NEC that require surgery is in part due to the lower gestational age, lower APGAR, higher need for ventilator support at birth, and requirement for vasoactive drugs for circulatory support. Patients presenting with abdominal distention rather than hematochezia are at higher risk for requiring surgery. These data will be used to help predict outcome, plan therapy, and advise parents.
