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CC BY 4.0 · Eur J Pediatr Surg
DOI: 10.1055/a-2536-4757
Original Article

Risk Factors for 30-day Mortality in Patients with Surgically Treated Necrotizing Enterocolitis: A Multicenter Retrospective Cohort Study

Adinda G.H. Pijpers  ‡   *
1   Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
2   Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
3   Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands
,
Ceren Imren‡   *
4   Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands
,
Otis C. van Varsseveld 
5   Department of Surgery, Division of Pediatric Surgery, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
,
Laurens D. Eeftinck Schattenkerk
1   Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
2   Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
3   Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands
,
Claudia M.G. Keyzer-Dekker
4   Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands
,
Jan B.F. Hulscher
5   Department of Surgery, Division of Pediatric Surgery, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
,
Elisabeth M.W. Kooi
6   Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
,
Chris H.P. van den Akker 
2   Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
3   Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands
7   Department of Pediatrics, Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
,
Joost van Schuppen
8   Department of Radiology and Nuclear Medicine, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
,
H. Rob Taal
9   Department of Neonatal and Paediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands
,
Jos W.R. Twisk
10   Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
,
Joep P.M. Derikx
1   Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
2   Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
3   Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands
,
Marijn J. Vermeulen
9   Department of Neonatal and Paediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Abstract

Purpose

Necrotizing enterocolitis (NEC) is a leading cause of death in very preterm born infants. The most severe variant is NEC totalis (NEC-T), where necrosis of the small intestines is so extensive that curative care is often withdrawn. Mortality and NEC-T are difficult to predict before surgery, complicating counseling and decision-making. This study's aim was to identify preoperative risk factors for overall 30-day mortality and NEC-T in preterm born infants with surgical NEC.

Methods

This multicenter retrospective cohort study included preterm born infants (<35 weeks) surgically treated for NEC between 2008 and 2022. NEC-T was defined as necrosis of the majority of small intestine, leading to a surgical open-close procedure without curative treatment. Preoperative risk factors for 30-day postoperative mortality, NEC-T, and mortality without NEC-T were assessed using multivariable logistic regression analyses.

Results

Among the 401 patients included, the 30-day mortality rate was 34.2% (137/401), of which 18.7% (75/401) involved NEC-T. Significant risk factors for mortality were male sex (odds ratio [OR]: 2.53; 95% confidence interval [CI]: 1.54–4.16), lower birthweight (OR: 0.91; 95% CI: 0.86–0.96/100 g), portal venous gas (PVG) on abdominal radiograph (OR: 1.89; 95% CI: 1.11–3.20), need for cardiovascular support between NEC diagnosis and surgery (OR: 3.26; 95% CI: 2.02–5.24), and shorter time between diagnosis and surgery (OR: 0.74; 95% CI: 0.65–0.84). Similar risk factors were found for NEC-T. In patients without NEC-T, the need for cardiovascular support (OR: 2.33; 95% CI: 1.33–4.09) and time between diagnosis and surgery (OR: 0.77; 95% CI: 0.64–0.91) were significant.

Conclusion

Male sex, lower birthweight, PVG, cardiovascular support, and a short interval between NEC diagnosis and surgery are preoperative risk factors for 30-day mortality and NEC-T. Preoperative cardiovascular support and a shorter time interval between diagnosis and surgery are also risk factors for mortality without NEC-T.

Level of evidence

II

Keywords

NEC totalis - portal venous gas - neonates - cardiovascular support

* These authors contributed equally.


Supplementary Material



Publikationsverlauf

Eingereicht: 05. September 2024

Angenommen: 09. Februar 2025

Artikel online veröffentlicht:
21. März 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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