Prognosis and Predictive Factors according to Extent of Involvement in Necrotizing Enterocolitis among Very Low Birth Weight Infants.

Heo,  Ju Sun; Jung,  Young Hwa; Lee,  Juyoung; Shin,  Seung Han; Kim,  Ee Kyung; Kim,  Han Suk; Choi,  Jung Hwan

doi:2015.22.2.98

Neonatal Med > Volume 22(2); 2015 > Article

Original Article

Neonatal Medicine 2015;22(2):98-104.
DOI: https://doi.org/10.5385/nm.2015.22.2.98 Published online May 29, 2015.

Prognosis and Predictive Factors according to Extent of Involvement in Necrotizing Enterocolitis among Very Low Birth Weight Infants.

Ju Sun Heo, Young Hwa Jung, Juyoung Lee, Seung Han Shin, Ee Kyung Kim, Han Suk Kim, Jung Hwan Choi

Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea. kimhans@snu.ac.kr

Abstract

PURPOSE
This study aimed to evaluate the prognosis of necrotizing enterocolitis (NEC) according to the extent of involvement, among very low birth weight infants. Furthermore, the predictive factors for extent of involvement were evaluated.
METHODS
Medical records of all newborns with surgically treated NEC admitted to the neonatal intensive care unit of Seoul National University Children's Hospital between 2005 and 2013 were reviewed. Infants were grouped according to the extent of involvement of NEC: isolated segment involvement (ISI, n=31) and multi-segment involvement (MSI, n=17). We evaluated the clinical characteristics, outcomes, and pre-operative factors according to symptoms, laboratory and radiologic findings.
RESULTS
The incidence of small for gestational age was significantly higher in the MSI than ISI group (12.9% vs. 41.2%, P=0.036). The length of resected bowel was significantly longer (1.7 cm vs. 8 cm, P=0.010), and the incidence of short bowel syndrome (SBS) (0% vs. 23.1%, P=0.023) and mortality (3.2% vs. 23.5%, P=0.047) were significantly higher in the MSI than ISI group. However, there was no significant difference between the two groups in terms of high-output stoma, time of full enteral feeding, extrauterine growth retardation, changes of z-score of body weight between admission and discharge and reoperation. Portal vein gas detected by ultrasonography was the only statistically significant predictive factor of extent of involvement (odds ratio=13.237, P=0.029).
CONCLUSION
SBS and mortality were higher in MSI NEC compared to ISI NEC. However, there was no difference in the time of full enteral feeding and growth between the two groups. Portal vein gas detected by ultrasonography maybe a predictive factor of extent of NEC.

Key Words: Necrotizing enterocolitis; Operation; Infant; Very low birth weight; Portal vein gas