LAUSR

Introduction Necrotising enterocolitis (NEC) is the most serious and frequent gastrointestinal emergency in the neonatal intensive care unit, (NICU) and is a major cause of death in premature infants. It is also associated with considerable morbidity, including increased respiratory support and level of care, need for intravenous antibiotics and total parenteral nutrition (TPN), and has long-term effects on growth and neurodevelopment. Aim This study aims to evaluate the difference in mortality and short-term morbidity between infants with medically and surgically treated NEC in a tertiary-level surgical neonatal unit in Cambridge, England. Methods This retrospective analysis of prospectively collected data evaluated infants with a diagnosis of NEC between 1st January 2009 and 31st December 2011. Diagnosis was made using modified Bells criteria and infants were defined into two groups by the treatment received. Medical NEC was treated with standard therapy of 7 days of broad spectrum intravenous antibiotics and withholding of enteral feeding, while surgical NEC was defined as the requirement for operative intervention; either laparotomy or placement of a peritoneal drain. Results During the 3-year study period, 152 infants were diagnosed with NEC and met inclusion criteria. Of these, 82 required medical management only and 70 required surgical intervention in addition to the standard medical treatment. There was a significant difference in mortality between the two groups with survival in the medically managed group of 96% vs. 61% in the operative group (p≤0.0001). The surgical group had a statistically significant higher rate of NEC recurrence (14% versus 28.5%, p=0.03). The surgical group had more days of ventilation (7 vs 13.5, p=0.001), more days on TPN (26 vs 46 p<0.0001) and were more likely to receive surgical central line insertion under general anaesthetic (11% vs 26%, p=0.02). There were no significant differences in gestation or birth weight, type of feeding or early somatic growth. Conclusion This is the largest single centre study comparing these two treatment groups and provides accurate contemporaneous data with which to counsel families. Operative NEC is associated with greater mortality and a higher rate of recurrence when compared with medical NEC. There is also significant morbidity associated with surgical NEC, including longer ventilation and long-term use of total parenteral nutrition, which has associated complications and sequelae.