Initiation of oral intake in neonates with surgical necrotizing enterocolitis: a road map.

IF 1.6 3区医学 Q2 PEDIATRICS

Pediatric Surgery International Pub Date : 2025-10-02 DOI:10.1007/s00383-025-06202-8

Mazen Omar Kurdi, Mohamed Ali Shehata, Nagi Ibrahim Eldessouki, Ahmed Mukhtar, Heidi Al-Wassia, Maha Bamehrez, Mohammad Gharieb Khirallah

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引用次数: 0

Abstract

Purpose: Necrotizing enterocolitis (NEC) is a severely life-threatening gastrointestinal emergency in newborns, especially when surgical intervention is needed. The ideal time for resuming oral feeding after surgery is still unclear, leading to variations in practice and prolonged parenteral nutrition. This study aims to develop and validate a scoring system to determine the best time to reintroduce oral feeding in neonates following surgical NEC.

Methods: A multicenter retrospective study was conducted from 2016 to 2024, including 500 neonates with surgical NEC (Bell's Stage III-IV). Patients were divided into early (5 days), intermediate (8-14 days), and delayed (≥ 15 days) feeding groups. A predictive score was constructed on 100 patients using eight preoperative, intraoperative, and postoperative variables. Validation was performed on an independent cohort of 400 patients.

Results: The scoring system demonstrated strong predictive accuracy (AUC = 0.967). Variables such as localized pneumatosis, absence of portal venous gas, higher platelet count, no second-look laparotomy, and early normalization of nasogastric aspirates and lab parameters were significantly associated with early feeding tolerance (p < 0.05). Validation confirmed reproducibility across cohorts without NEC recurrence or feeding-related complications.

Conclusion: We present a validated, clinically practical scoring system to guide early oral intake initiation after NEC surgery. It enables stratified decision-making, reduces reliance on parenteral nutrition, and enhances postoperative recovery.

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新生儿手术坏死性小肠结肠炎的开始口服摄入：路线图。

目的：坏死性小肠结肠炎（NEC）是新生儿严重危及生命的胃肠道急症，尤其是需要手术干预时。手术后恢复口服喂养的理想时间仍不清楚，导致实践中的变化和延长肠外营养。本研究旨在开发和验证一个评分系统，以确定在新生儿手术NEC后重新引入口服喂养的最佳时间。方法：对2016年至2024年500例外科NEC （Bell’s III-IV期）新生儿进行多中心回顾性研究。患者分为早期（5 d）、中期（8-14 d）和延迟（≥15 d）喂养组。采用术前、术中、术后8个变量对100例患者进行预测评分。在400名患者的独立队列中进行验证。结果：评分系统具有较强的预测准确度（AUC = 0.967）。局部气肺、门静脉气体缺乏、血小板计数较高、无二次剖腹手术、鼻胃抽吸物和实验室参数早期正常化等变量与早期进食耐受显著相关(p)。结论：我们提出了一个经过验证的、临床实用的评分系统，用于指导NEC手术后早期开始口服进食。它使分层决策，减少对肠外营养的依赖，并提高术后恢复。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Surgery International 医学-外科

CiteScore

3.00

自引率

5.60%

发文量

215

审稿时长

3-6 weeks

期刊介绍： Pediatric Surgery International is a journal devoted to the publication of new and important information from the entire spectrum of pediatric surgery. The major purpose of the journal is to promote postgraduate training and further education in the surgery of infants and children. The contents will include articles in clinical and experimental surgery, as well as related fields. One section of each issue is devoted to a special topic, with invited contributions from recognized authorities. Other sections will include: -Review articles- Original articles- Technical innovations- Letters to the editor