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Eur J Pediatr Surg 2014; 24(05): 394-397
DOI: 10.1055/s-0033-1351665
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Mortality of Necrotizing Enterocolitis and Isolated Ileal Perforation at a Single Institution over the Past 40 Years

E. Marty Knott
1   Department of Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
,
Alessandra Gasior
1   Department of Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
,
Shawn St Peter
1   Department of Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
,
Charles Snyder
1   Department of Surgery, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
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Publikationsverlauf

25. Mai 2013

26. Juni 2013

Publikationsdatum:
29. Juli 2013 (online)

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Abstract

Purpose Controversy exists regarding differences in mortality between isolated ileal perforation (IIP) and necrotizing enterocolitis (NEC). We sought to identify risk factors and determine mortality rates for these two entities.

Methods A retrospective review was conducted on all patients with NEC or IIP undergoing surgical management at our institution from May 1971 to December 2011. Demographics, birth history, management strategies, and mortality were recorded. Chi-square and unpaired t-test were used where appropriate.

Results During the study period, 236 patients underwent operative management with 17.8% of those being for IIP. Patients with IIP had a lower estimated gestational age (27.8 ± 3.0 vs. 29.5 ± 4.2 weeks, p = 0.014), were more likely to be of multiple gestation (33.3 vs. 16.5%, p = 0.022), and were younger at diagnosis (8.7 ± 8.1 vs. 14.3 ± 11.1 days, p = 0.003) compared with those undergoing operation for NEC. Mortality was threefold lower with IIP (9.5 vs. 36.1%, p < 0.001).

Conclusions IIP carries a unique set of risk factors and has a significantly lower mortality rate when compared with NEC.

Keywords

necrotizing enterocolitis - isolated intestinal perforation - mortality - risk factors
 

  • References

  • 1 Grosfeld JL, Cheu H, Schlatter M , et al. Changing trends in necrotizing enterocolitis. Experience with 302 cases in two decades. Ann Surg 1991; 214: 300-306
    CrossrefPubMedSuche in Google Scholar
  • 2 Zamir O, Goldberg M, Udassin R, Peleg O, Nissan S, Eyal F. Idiopathic gastrointestinal perforation in the neonate. J Pediatr Surg 1988; 23 (4) 335-337
    CrossrefPubMedSuche in Google Scholar
  • 3 Meyer CL, Payne NR, Roback SA. Spontaneous, isolated intestinal perforations in neonates with birth weight less than 1,000.  g not associated with necrotizing enterocolitis. J Pediatr Surg 1991; 26 (6) 714-717
    CrossrefPubMedSuche in Google Scholar
  • 4 Mintz AC, Applebaum H. Focal gastrointestinal perforations not associated with necrotizing enterocolitis in very low birth weight neonates. J Pediatr Surg 1993; 28 (6) 857-860
    CrossrefPubMedSuche in Google Scholar
  • 5 Weinberg G, Kleinhaus S, Boley SJ. Idiopathic intestinal perforations in the newborn: an increasingly common entity. J Pediatr Surg 1989; 24 (10) 1007-1008
    CrossrefPubMedSuche in Google Scholar
  • 6 Hwang H, Murphy JJ, Gow KW, Magee JF, Bekhit E, Jamieson D. Are localized intestinal perforations distinct from necrotizing enterocolitis?. J Pediatr Surg 2003; 38 (5) 763-767
    CrossrefPubMedSuche in Google Scholar
  • 7 St-Vil D, LeBouthillier G, Luks FI, Bensoussan AL, Blanchard H, Youssef S. Neonatal gastrointestinal perforations. J Pediatr Surg 1992; 27 (10) 1340-1342
    CrossrefPubMedSuche in Google Scholar
  • 8 Zamir O, Shapira SC, Udassin R, Peleg O, Arad I, Nissan S. Gastrointestinal perforations in the neonatal period. Am J Perinatol 1988; 5 (2) 131-133
    Thieme ConnectPubMedSuche in Google Scholar
  • 9 Buchheit JQ, Stewart DL. Clinical comparison of localized intestinal perforation and necrotizing enterocolitis in neonates. Pediatrics 1994; 93 (1) 32-36
    PubMedSuche in Google Scholar
  • 10 Tatekawa Y, Muraji T, Imai Y, Nishijima E, Tsugawa C. The mechanism of focal intestinal perforations in neonates with low birth weight. Pediatr Surg Int 1999; 15 (8) 549-552
    CrossrefPubMedSuche in Google Scholar
  • 11 Kubota A, Yamanaka H, Okuyama H , et al. Focal intestinal perforation in extremely-low-birth-weight neonates: etiological consideration from histological findings. Pediatr Surg Int 2007; 23 (10) 997-1000
    CrossrefPubMedSuche in Google Scholar
  • 12 Coates EW, Karlowicz MG, Croitoru DP, Buescher ES. Distinctive distribution of pathogens associated with peritonitis in neonates with focal intestinal perforation compared with necrotizing enterocolitis. Pediatrics 2005; 116 (2) e241-e246
    CrossrefPubMedSuche in Google Scholar
  • 13 Ragouilliaux CJ, Keeney SE, Hawkins HK, Rowen JL. Maternal factors in extremely low birth weight infants who develop spontaneous intestinal perforation. Pediatrics 2007; 120 (6) e1458-e1464
    CrossrefPubMedSuche in Google Scholar
  • 14 Attridge JT, Clark R, Walker MW, Gordon PV. New insights into spontaneous intestinal perforation using a national data set: (1) SIP is associated with early indomethacin exposure. J Perinatol 2006; 26 (2) 93-99
    CrossrefPubMedSuche in Google Scholar
  • 15 Attridge JT, Clark R, Walker MW, Gordon PV. New insights into spontaneous intestinal perforation using a national data set: (2) two populations of patients with perforations. J Perinatol 2006; 26 (3) 185-188
    CrossrefPubMedSuche in Google Scholar
  • 16 Attridge JT, Clark R, Gordon PV. New insights into spontaneous intestinal perforation using a national data set (3): antenatal steroids have no adverse association with spontaneous intestinal perforation. J Perinatol 2006; 26 (11) 667-670
    CrossrefPubMedSuche in Google Scholar
  • 17 Paquette L, Friedlich P, Ramanathan R, Seri I. Concurrent use of indomethacin and dexamethasone increases the risk of spontaneous intestinal perforation in very low birth weight neonates. J Perinatol 2006; 26 (8) 486-492
    CrossrefPubMedSuche in Google Scholar
  • 18 Thyoka M, de Coppi P, Eaton S , et al. Advanced necrotizing enterocolitis part 1: mortality. Eur J Pediatr Surg 2012; 22 (1) 8-12
    Thieme ConnectPubMedSuche in Google Scholar
  • 19 Adderson EE, Pappin A, Pavia AT. Spontaneous intestinal perforation in premature infants: a distinct clinical entity associated with systemic candidiasis. J Pediatr Surg 1998; 33 (10) 1463-1467
    CrossrefPubMedSuche in Google Scholar
  • 20 Aschner JL, Deluga KS, Metlay LA, Emmens RW, Hendricks-Munoz KD. Spontaneous focal gastrointestinal perforation in very low birth weight infants. J Pediatr 1988; 113 (2) 364-367
    CrossrefPubMedSuche in Google Scholar
  • 21 Alpan G, Eyal F, Vinograd I , et al. Localized intestinal perforations after enteral administration of indomethacin in premature infants. J Pediatr 1985; 106 (2) 277-281
    CrossrefPubMedSuche in Google Scholar
  • 22 Nagaraj HS, Sandhu AS, Cook LN, Buchino JJ, Groff DB. Gastrointestinal perforation following indomethacin therapy in very low birth weight infants. J Pediatr Surg 1981; 16 (6) 1003-1007
    CrossrefPubMedSuche in Google Scholar
  • 23 Kirkby S, Genen L, Turenne W, Dysart K. Outcomes and milestone achievement differences for very low-birth-weight multiples compared with singleton infants. Am J Perinatol 2010; 27 (6) 439-444
    Thieme ConnectPubMedSuche in Google Scholar
  • 24 Powell RW, Dyess DL, Luterman A, Simon NP, Ramenofsky ML. Necrotizing enterocolitis in multiple-birth infants. J Pediatr Surg 1990; 25 (3) 319-321
    CrossrefPubMedSuche in Google Scholar
  • 25 Samm M, Curtis-Cohen M, Keller M, Chawla H. Necrotizing enterocolitis in infants of multiple gestation. Am J Dis Child 1986; 140 (9) 937-939
    PubMedSuche in Google Scholar
  • 26 Gephart SM, McGrath JM, Effken JA, Halpern MD. Necrotizing enterocolitis risk: state of the science. Adv Neonatal Care 2012; 12 (2) 77-87 , quiz 88–89
    CrossrefPubMedSuche in Google Scholar
  • 27 Krishnamurthy S, Gupta P, Debnath S, Gomber S. Slow versus rapid enteral feeding advancement in preterm newborn infants 1000-1499.  g: a randomized controlled trial. Acta Paediatr 2010; 99 (1) 42-46
    CrossrefPubMedSuche in Google Scholar
  • 28 Karagol BS, Zenciroglu A, Okumus N, Polin RA. Randomized controlled trial of slow vs rapid enteral feeding advancements on the clinical outcomes of preterm infants with birth weight 750-1250 g. JPEN J Parenter Enteral Nutr 2013; 37 (2) 223-228
    CrossrefPubMedSuche in Google Scholar