Surgical necrotizing enterocolitis: are intestinal lesions more severe in infants with low birth weight?

PURPOSE

This study examines whether the intestinal lesions of necrotizing enterocolitis (NEC) in infants undergoing surgery are more severe in patients with extremely low birth weight (BW).

METHODS

Between 1980 and 2000, 128 infants underwent laparotomy for NEC: 90 in the acute phase, and 38 for secondary stenosis. Resections were limited to areas of transparietal bowel necrosis and to secondary stenoses. The authors studied the extent of initial bowel lesions at initial laparotomy, and, in the survivors, the extent of bowel resections and the existence of digestive sequelae, with a median follow-up of 24 (range, 1 to 247) months. Children with BW < or =1,000 g (group 1, 22 patients) and greater than 1,000 g (group 2, 103 patients) were compared by using chi(2) and t test.

RESULTS

Patients' survival rate was 87%: 68% and 91% in the groups 1 and 2, respectively (P =.01). No significant difference between the 2 groups was seen: (1) for the rate of patients with panintestinal lesions at initial surgery (12%); (2) in the survivors, the ratio of remaining to total length of jejuno-ileum (mean 88%), the number of colonic segments resected (mean 1.2), the rate of survivors without distal ileum (34%), ileo-caecal valve (39%), or right colon (29%); and (3) for the existence of digestive symptoms, even minor, at last follow-up (25%).

CONCLUSIONS

Although the prognosis of surgical NEC was worse in infants with extremely low birth weight, the intestinal lesions were not found more severe in these patients.