Stepwise Management of Necrotizing Enterocolitis Could Improve Outcome of this Life-Threatening Disease

Abdel Maksod YH, Shahin AM, Ahmed H* and Aabdelwahab MB, Departments of Pediatrics and General Surgery, Faculty of Medicine, Benha University, Egypt

Abstract

Objectives:

To present various lines of management of infants with necrotizing enterocolitis (NEC) and to outline its outcome.

Patients and Methods:

This prospective study included 127 neonates met Bell' s criteria for NEC diagnosis. All neonates were managed at NICU. Whenever indicated emergency laparotomy (EL) was performed. Medical management included no oral feeding, gastric suction, parentral nutrition, intravenous antibiotic therapy and cardiorespiratory support till patients start to thrive. Then, enteral feeding tolerance was tested and was started with mothers' milk given gradually. Bedside diagnostic mini-laparoscopy was performed for non-responders to medical intervention and if possible, dealing with pathology was conducted. Postoperative care was provided at NICU and patients were monitored for full recovery, development of additional morbidities or death.

Results:

Thirty-nine patients required EL, while 88 patients underwent the medical intervention trial. Fifty-four cases responded to medical treatment and tolerated oral feeding within a mean duration of 39.3 ± 8.4 days. Bedside laparoscopy was performed for 34 non-responders and was therapeutic in 10 and preparatory for EL in 6 and reduced the need for EL in 18 cases. Fifty-seven patients tolerated oral feeding and started to thrive uneventfully, while 70 patients developed additional morbidities; 19 after medical and 51 after surgical intervention. Thirty-five patients died; 5 after medical and 30 after surgical intervention with significantly higher success rate and lower morbidity and mortality rates among patients had medical intervention compared to patients had surgical intervention.

Conclusion:

Medical treatment and early gradual entral feeding with breast milk provided success rate of 61.4%. Bed-side laparoscopy is promising adjuvant diagnostic and therapeutic modality for non-responders to medical intervention. Mortality rate was significantly higher with surgical interference, so could be preserved only whenever indicated.

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