TY - JOUR
T1 - Surgical outcomes for necrotizing enterocolitis in Dutch infants born before 26 weeks' gestation
AU - van Varsseveld, Otis C
AU - Pijpers, Adinda G H
AU - Imren, Ceren
AU - Derikx, Joep P M
AU - van den Akker, Chris H P
AU - van Schuppen, Joost
AU - Keyzer-Dekker, Claudia M G
AU - Vermeulen, Marijn J
AU - Schurink, Maarten
AU - Lindeboom, Maud Y A
AU - Kooi, Elisabeth M W
AU - Hulscher, Jan B F
N1 - Publisher Copyright:
© The Author(s) 2025. Published by Oxford University Press on behalf of BJS Foundation Ltd.
PY - 2025/5/7
Y1 - 2025/5/7
N2 - Background: In infants born at < 26 weeks of gestational age (wGA) who develop necrotizing enterocolitis (NEC), medical and ethical considerations about whether surgery is the optimal treatment are complicated by a lack of group-specific outcome data. This study investigated nationwide 30-day mortality, surgical complications, and preoperative mortality risk factors in infants born at < 26 wGA who underwent surgery during the active phase of NEC. Methods: This retrospective nationwide multicentre study included all infants born at < 26 wGA undergoing surgery for Bell’s stage II/III NEC in the Netherlands between 2008 and 2022, regardless of outcome. Severe NEC was defined as Bell’s stage III (confirmed by laparotomy and/or leading to death). The primary outcome was postoperative 30-day mortality. The incidence of major postoperative complications (Clavien–Madadi III–IV) was determined after excluding infants undergoing open–close procedures for massive bowel necrosis. Potential risk factors for death after surgery were assessed using multivariable logistic regression. Results: Of 288 infants with NEC Bell’s stage ≥ II, 80 (27.8%) survived without surgery, 66 (22.9%) died before laparotomy, and 142 (49.3%) underwent laparotomy. In 142 surgically treated infants with severe NEC (57.0% male), the median gestational age was 25 + 0 (range 23 + 6 to 25 + 6) weeks + days, the median birthweight was 750 (range 485–1070) g, and the median age at surgery was 14 (range 2–66) days. Primary open–close surgery was performed in 34 of 142 infants (23.9%). In the remaining 108 infants, surgical management included stoma creation (63.0%), primary anastomosis (27.8%), or both (9.3%). Overall, the 30-day mortality rate among 142 infants was 47.2% (67 deaths). Death occurred after a primary or second-look open–close procedure in 37 infants, after multiorgan failure in 17, and from other causes in the remaining 13. After excluding 37 infants who died after open–close procedures, 30-day complications occurred in 23 (21.9%) of 105 surgically treated infants. There were 29 events in total, including reoperation for bowel perforation (5, 17%) or anastomotic leak/stenosis (5, 17%). Regression analysis identified no risk factors for 30-day mortality. Conclusion: The 30-day mortality rate was 47.2% in infants born at < 26 wGA undergoing NEC surgery, most of whom died after an open–close procedure. Another 21.9% of infants experienced major complications.
AB - Background: In infants born at < 26 weeks of gestational age (wGA) who develop necrotizing enterocolitis (NEC), medical and ethical considerations about whether surgery is the optimal treatment are complicated by a lack of group-specific outcome data. This study investigated nationwide 30-day mortality, surgical complications, and preoperative mortality risk factors in infants born at < 26 wGA who underwent surgery during the active phase of NEC. Methods: This retrospective nationwide multicentre study included all infants born at < 26 wGA undergoing surgery for Bell’s stage II/III NEC in the Netherlands between 2008 and 2022, regardless of outcome. Severe NEC was defined as Bell’s stage III (confirmed by laparotomy and/or leading to death). The primary outcome was postoperative 30-day mortality. The incidence of major postoperative complications (Clavien–Madadi III–IV) was determined after excluding infants undergoing open–close procedures for massive bowel necrosis. Potential risk factors for death after surgery were assessed using multivariable logistic regression. Results: Of 288 infants with NEC Bell’s stage ≥ II, 80 (27.8%) survived without surgery, 66 (22.9%) died before laparotomy, and 142 (49.3%) underwent laparotomy. In 142 surgically treated infants with severe NEC (57.0% male), the median gestational age was 25 + 0 (range 23 + 6 to 25 + 6) weeks + days, the median birthweight was 750 (range 485–1070) g, and the median age at surgery was 14 (range 2–66) days. Primary open–close surgery was performed in 34 of 142 infants (23.9%). In the remaining 108 infants, surgical management included stoma creation (63.0%), primary anastomosis (27.8%), or both (9.3%). Overall, the 30-day mortality rate among 142 infants was 47.2% (67 deaths). Death occurred after a primary or second-look open–close procedure in 37 infants, after multiorgan failure in 17, and from other causes in the remaining 13. After excluding 37 infants who died after open–close procedures, 30-day complications occurred in 23 (21.9%) of 105 surgically treated infants. There were 29 events in total, including reoperation for bowel perforation (5, 17%) or anastomotic leak/stenosis (5, 17%). Regression analysis identified no risk factors for 30-day mortality. Conclusion: The 30-day mortality rate was 47.2% in infants born at < 26 wGA undergoing NEC surgery, most of whom died after an open–close procedure. Another 21.9% of infants experienced major complications.
KW - Enterocolitis, Necrotizing/surgery
KW - Female
KW - Gestational Age
KW - Humans
KW - Infant
KW - Infant, Newborn
KW - Infant, Premature
KW - Infant, Premature, Diseases/surgery
KW - Laparotomy
KW - Male
KW - Netherlands/epidemiology
KW - Postoperative Complications/epidemiology
KW - Retrospective Studies
KW - Risk Factors
KW - Treatment Outcome
U2 - 10.1093/bjsopen/zraf060
DO - 10.1093/bjsopen/zraf060
M3 - Article
C2 - 40407731
SN - 2474-9842
VL - 9
JO - BJS open
JF - BJS open
IS - 3
M1 - zraf060
ER -