T. F. Hamner1, 2, 3, D. J. Kim1, 2, 3, C. E. Wilkin1, 2, 3, B. N. Hegde1, 2, 3, E. I. Garcia1, 2, 3, N. B. Hebballi1, 2, 3, M. Broussard1, 2, 3, S. Arshad1, 2, 3, A. L. Speer1, 2, 3, K. Tsao1, 2, 3 1McGovern Medical School at the University of Texas Health Science Center at Houston, Department Of Pediatric Surgery, Houston, TX, USA 2McGovern Medical School at the University of Texas Health Science Center at Houston, Center For Surgical Trials And Evidence-Based Practice (C-STEP), Houston, TX, USA 3Children’s Memorial Hermann Hospital, Houston, TX, USA
Introduction:
Necrotizing Enterocolitis (NEC) is a common gastrointestinal disease in premature infants and one of the leading causes of morbidity and mortality amongst this patient population. In addition to operative intervention for severe cases, all treatment includes bowel rest and intravenous antibiotics; however, there are no standardized guidelines for duration of therapy, especially in non-operative management of NEC. This study evaluated our institution's use of antibiotics for NEC for both operative and non-operative patients.
Methods:
A retrospective study was conducted of pediatric (age<1 year) NEC cases at a tertiary-care pediatric hospital from January 2018-December 2020. Patient demographics, diagnosis, operative details, treatment plans, and outcomes within 90 days post-operatively were collected from the electronic medical record. Patients who had a confirmed NEC diagnosis and those with suspected NEC were included in the study. Descriptive and univariate analysis was performed.
Results:
Of the 99 patients treated for NEC, 49 (49.5%) were male. The median age at diagnosis was 20 (10,41) days with a median weight of 1.25 (0.91,1.92) kilograms. Forty-three (43.4%) patients underwent surgery, while 56 (56.6%) were treated exclusively with antibiotics and bowel rest. The most common antibiotic regimen used was a combination of gentamicin, ampicillin, and flagyl (44.4%), but regimens were variable with 32 different antibiotic regimens being chosen for treatment. Operative patients were more frequently placed on antibiotics for longer than 14 days ((15 (35%) vs. 5 (9%) p=0.001). Non-operative patients were more frequently placed on antibiotics for 7 to 14 days ((38 (68%) vs. 17 (40%) p=0.005). Despite this variability, there was no difference in median total antibiotic duration between operative vs non-operative patients ((10 (6,18) vs. 8 (7,11) p=0.06). Patients who underwent an operation were noted to have more complications ((9 (21%) vs. 4 (7%) p=0.044); however, they did not have an increased length of stay ((80.5 (18.0,157.4) vs. 76.0 (48.4,117.9) p=0.44). In total, 14 (14.1%) patients died from complications directly related to NEC.
Conclusion:
Antibiotic therapy for treatment of NEC at our institution was highly variable. Despite this variability, there was no difference in median total antibiotic duration between non-operative vs operative patients. However, operative patients did have more complications. Institutional antibiotic stewardship is needed to create a uniform antibiotic treatment protocol for NEC that provides ease of use for providers and optimizes patient outcomes.