The Outcome of Primary Anastomosis and the Long Term Follow Up of Preterm Infants Undergoing Surgery for Necrotizing Enterocolitis

Abstract

Objective: To investigate the safety and effectiveness of primary anastomosis (PA) in infants with complicated necrotizing enterocolitis (NEC) and the short and long-term outcomes, including the neurodevelopmental outcomes. Methods: A retrospective analysis of medical records of all infants diagnosed with NEC in the years 2000-2016. Long-term outcome data were taken from medical records and parental questionnaires. Results: Of 98 infants diagnosed with NEC, 40 were surgically treated (22 PA, 9 stoma, 9 peritoneal drainage (PD)). PA had shorter length of parenteral nutrition (20 vs. 34 days, p= 0.215), antibiotic treatment (10 vs. 14 days, p=0.053) and hospitalization (48 vs. 106 days, p=0.026) compared to stoma. Stoma group infants who needed more than one surgical intervention due to complications was three times higher (66% vs 22%, p= 0.038) and 57% of stoma infants developed short bowel syndrome compared to 33% of PA infants. There was no statistically significant difference between PA and stoma in mortality rate (27% vs 22%, p=1.00). Normal development at 1-2 years after discharge was found in 40% of PA and 14% of stoma. Severe neurodevelopmental impairment (NDI) was more common in stoma (70%) than in PA (20%). 70% of PA infants were integrated into a regular education framework compared to 28% of stoma. Conclusion: safe and effective surgical technique in the management of complicated NEC, with the same mortality rate as stoma, but, with lower morbidity in the short term and better long-term neurodevelopmental outcomes.