Conservative Management of Necrotizing Enterocolitis in Newborns: Incidence and Management of Intestinal Strictures.

IF 1.5 3区 医学 Q2 PEDIATRICS
Rach Mena, Gabriela Guillén, Sergio Lopez-Fernandez, Marta Martos Rodríguez, César W Ruiz, Alicia Montaner-Ramon, Manuel López, José A Molino
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Abstract

Background:  Necrotizing enterocolitis (NEC) is one of the main causes of acute abdomen in neonates. Surgical treatment entails important morbidity and mortality and conservative management, when possible, offers better outcomes. Post-NEC intestinal strictures are one of the main complications.

Methods: Retrospective analysis from June 2011 to November 2022 of post-NEC strictures (PNS) after conservative management of neonates diagnosed with NEC (modified Bell stage IIA or higher) at a tertiary neonatal surgery center.

Results:  Out of 219 NEC, 126 received initial conservative management (57.5%), 24 (19%) of which eventually underwent surgery for PNS. Average gestational age and weight at birth of our cohort were 31.3 ± 4.9 weeks and 1,694 ± 1,009 g.PNS diagnosis was made 38.4 ± 16.5 days after the NEC episode. 6/24 (25%) were asymptomatic and diagnosed by screening enema, 11 (46%) presented signs of intestinal obstruction before the enema could be performed and 7 (29%) after a normal previous protocol study.Median age at PNS surgery was 56 ± 17.9 days. A total of 2/3 strictures were found in cecum, ascendent, and transverse colon. Primary resection and anastomosis were performed in all cases. Feeds were restarted on postoperative day 4.3 ± 2.9. Two cases presented anastomotic complications (1 dehiscence and 1 stenosis), and no deaths were recorded.

Conclusions:  PNS is a frequent complication after conservative management. Deffered surgical treatment after the acute NEC episode is resolved allows for safer surgeries (since patients have reached hemodynamical stability and overcome septic shock), shorter resections, and favorable postoperative outcomes.

新生儿坏死性小肠结肠炎的保守治疗:肠狭窄的发生率和治疗。
背景坏死性小肠结肠炎(NEC)是导致新生儿急腹症的主要原因之一。手术治疗会导致严重的发病率和死亡率,而保守治疗在可能的情况下会取得更好的疗效。NEC 后肠道狭窄是主要并发症之一。 方法 回顾性分析 2011 年 6 月至 2022 年 11 月在一家三级新生儿外科中心确诊为 NEC(改良贝尔 IIA 期或更高)的新生儿保守治疗后出现的 NEC 后肠道狭窄(PNS)。 结果 在 219 例 NEC 中,126 例(57.5%)接受了初步保守治疗,其中 24 例(19%)最终接受了 PNS 手术治疗。该组患儿的平均胎龄和出生时体重分别为 31.3 ± 4.9 周和 1694 ± 1009 克。 PNS是在NEC发作后38.4 ± 16.5天确诊的。6/24(25%)的患儿无症状,通过筛查灌肠确诊,11(46%)的患儿在灌肠前出现肠梗阻症状,7(29%)的患儿在之前的方案检查正常后确诊。 PNS手术的中位年龄为56±17.9天。2/3的狭窄发生在盲肠、升结肠和横结肠。所有病例都进行了初级切除和吻合术。术后第 4.3 ± 2.9 天开始进食。2 例出现吻合并发症(1 例开裂,1 例狭窄),无死亡记录。 结论 产前小肠结肠炎后狭窄是保守治疗后的常见并发症。在急性 NEC 病情缓解后再进行手术治疗,可以使手术更安全(因为患者的血流动力学已经稳定,并克服了脓毒性休克)、缩短切除时间并获得良好的术后效果。
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来源期刊
CiteScore
3.90
自引率
5.60%
发文量
66
审稿时长
6-12 weeks
期刊介绍: This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements. You will find state-of-the-art information on: abdominal and thoracic surgery neurosurgery urology gynecology oncology orthopaedics traumatology anesthesiology child pathology embryology morphology Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.
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