Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation

A prospective cohort study by the NICHD Neonatal Research Network

Martin L. Blakely, Kevin P. Lally, Scott McDonald, Rebeccah L. Brown, Douglas C. Barnhart, Richard R. Ricketts, W. Raleigh Thompson, L. R. Scherer, Michael D. Klein, Robert W. Letton, Walter J. Chwals, Robert J. Touloukian, Arlett G. Kurkchubasche, Michael A. Skinner, R. Lawrence Moss, Mary L. Hilfiker, Max Langham, Wallace W. Neblett, Joseph P. Tepas, James A. O'Neill & 2 others J. Alex Haller, Charles E. Bagwell

Research output: Contribution to journalArticle

176 Citations (Scopus)

Abstract

Objective: Purposes of this study were: 1) to compare mortality and postoperative morbidities (intra-abdominal abscess, wound dehiscence, and intestinal stricture) in extremely low birth weight (ELBW) infants who underwent initial laparotomy or drainage for necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP); 2) to determine the ability to distinguish NEC from IP preoperatively and the importance of this distinction on outcome measures; and 3) to evaluate the association between extent of intestinal disease determined at operation and outcome measures. Background: ELBW infants who undergo operation for NEC or IP have a postoperative, in-hospital mortality rate of approximately 50%. Whether to perform laparotomy or drainage initially is controversial. Also unknown is the importance of distinguishing NEC from IP and the current ability to make this distinction based on objective data available prior to operation. Methods: A prospective, multicenter cohort study of 156 ELBW infants at 16 neonatal intensive care units (NICU) within the NICHD Neonatal Research Network. Results: Among the 156 enrolled infants, 80 underwent initial peritoneal drainage and 76 initial laparotomy. Mortality rate was 49% (76 of 156). Ninety-six patients had a preoperative diagnosis of NEC and 60 had presumed IP. There was a high level of agreement between the presumed preoperative diagnosis and intraoperative diagnosis in patients undergoing initial laparotomy (kappa = 0.85). The relative risk for death with a preoperative diagnosis of NEC (versus IP) was 1.4 (95% confidence interval, 0.99-2.1, P = 0.052). The overall incidence of postoperative intestinal stricture was 10.3%, wound dehiscence 4.4%, and intra-abdominal abscess 5.8%, and did not significantly differ between groups undergoing initial laparotomy versus initial drainage. Conclusions: Survival to hospital discharge after operation for NEC or IP in ELBW neonates remains poor (51%). Patients with a preoperative diagnosis of NEC have a relative risk for death of 1.4 compared with those with a preoperative diagnosis of IP. A distinction can be made preoperatively between NEC and IP based on abdominal radiographic findings and the patient's age at operation. Future randomized trials that compare laparotomy versus drainage would likely benefit from stratification of treatment assignment based on preoperative diagnosis.

Original languageEnglish (US)
Pages (from-to)984-994
Number of pages11
JournalAnnals of surgery
Volume241
Issue number6
DOIs
StatePublished - Jun 1 2005

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National Institute of Child Health and Human Development (U.S.)
Extremely Low Birth Weight Infant
Intestinal Perforation
Necrotizing Enterocolitis
Cohort Studies
Prospective Studies
Laparotomy
Research
Drainage
Abdominal Abscess
Mortality
Pathologic Constriction
Outcome Assessment (Health Care)
Intestinal Diseases
Neonatal Intensive Care Units
Wounds and Injuries
Low Birth Weight Infant
Hospital Mortality
Multicenter Studies
Newborn Infant

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation : A prospective cohort study by the NICHD Neonatal Research Network. / Blakely, Martin L.; Lally, Kevin P.; McDonald, Scott; Brown, Rebeccah L.; Barnhart, Douglas C.; Ricketts, Richard R.; Thompson, W. Raleigh; Scherer, L. R.; Klein, Michael D.; Letton, Robert W.; Chwals, Walter J.; Touloukian, Robert J.; Kurkchubasche, Arlett G.; Skinner, Michael A.; Moss, R. Lawrence; Hilfiker, Mary L.; Langham, Max; Neblett, Wallace W.; Tepas, Joseph P.; O'Neill, James A.; Haller, J. Alex; Bagwell, Charles E.

In: Annals of surgery, Vol. 241, No. 6, 01.06.2005, p. 984-994.

Research output: Contribution to journalArticle

Blakely, ML, Lally, KP, McDonald, S, Brown, RL, Barnhart, DC, Ricketts, RR, Thompson, WR, Scherer, LR, Klein, MD, Letton, RW, Chwals, WJ, Touloukian, RJ, Kurkchubasche, AG, Skinner, MA, Moss, RL, Hilfiker, ML, Langham, M, Neblett, WW, Tepas, JP, O'Neill, JA, Haller, JA & Bagwell, CE 2005, 'Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation: A prospective cohort study by the NICHD Neonatal Research Network', Annals of surgery, vol. 241, no. 6, pp. 984-994. https://doi.org/10.1097/01.sla.0000164181.67862.7f
Blakely, Martin L. ; Lally, Kevin P. ; McDonald, Scott ; Brown, Rebeccah L. ; Barnhart, Douglas C. ; Ricketts, Richard R. ; Thompson, W. Raleigh ; Scherer, L. R. ; Klein, Michael D. ; Letton, Robert W. ; Chwals, Walter J. ; Touloukian, Robert J. ; Kurkchubasche, Arlett G. ; Skinner, Michael A. ; Moss, R. Lawrence ; Hilfiker, Mary L. ; Langham, Max ; Neblett, Wallace W. ; Tepas, Joseph P. ; O'Neill, James A. ; Haller, J. Alex ; Bagwell, Charles E. / Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation : A prospective cohort study by the NICHD Neonatal Research Network. In: Annals of surgery. 2005 ; Vol. 241, No. 6. pp. 984-994.
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abstract = "Objective: Purposes of this study were: 1) to compare mortality and postoperative morbidities (intra-abdominal abscess, wound dehiscence, and intestinal stricture) in extremely low birth weight (ELBW) infants who underwent initial laparotomy or drainage for necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP); 2) to determine the ability to distinguish NEC from IP preoperatively and the importance of this distinction on outcome measures; and 3) to evaluate the association between extent of intestinal disease determined at operation and outcome measures. Background: ELBW infants who undergo operation for NEC or IP have a postoperative, in-hospital mortality rate of approximately 50{\%}. Whether to perform laparotomy or drainage initially is controversial. Also unknown is the importance of distinguishing NEC from IP and the current ability to make this distinction based on objective data available prior to operation. Methods: A prospective, multicenter cohort study of 156 ELBW infants at 16 neonatal intensive care units (NICU) within the NICHD Neonatal Research Network. Results: Among the 156 enrolled infants, 80 underwent initial peritoneal drainage and 76 initial laparotomy. Mortality rate was 49{\%} (76 of 156). Ninety-six patients had a preoperative diagnosis of NEC and 60 had presumed IP. There was a high level of agreement between the presumed preoperative diagnosis and intraoperative diagnosis in patients undergoing initial laparotomy (kappa = 0.85). The relative risk for death with a preoperative diagnosis of NEC (versus IP) was 1.4 (95{\%} confidence interval, 0.99-2.1, P = 0.052). The overall incidence of postoperative intestinal stricture was 10.3{\%}, wound dehiscence 4.4{\%}, and intra-abdominal abscess 5.8{\%}, and did not significantly differ between groups undergoing initial laparotomy versus initial drainage. Conclusions: Survival to hospital discharge after operation for NEC or IP in ELBW neonates remains poor (51{\%}). Patients with a preoperative diagnosis of NEC have a relative risk for death of 1.4 compared with those with a preoperative diagnosis of IP. A distinction can be made preoperatively between NEC and IP based on abdominal radiographic findings and the patient's age at operation. Future randomized trials that compare laparotomy versus drainage would likely benefit from stratification of treatment assignment based on preoperative diagnosis.",
author = "Blakely, {Martin L.} and Lally, {Kevin P.} and Scott McDonald and Brown, {Rebeccah L.} and Barnhart, {Douglas C.} and Ricketts, {Richard R.} and Thompson, {W. Raleigh} and Scherer, {L. R.} and Klein, {Michael D.} and Letton, {Robert W.} and Chwals, {Walter J.} and Touloukian, {Robert J.} and Kurkchubasche, {Arlett G.} and Skinner, {Michael A.} and Moss, {R. Lawrence} and Hilfiker, {Mary L.} and Max Langham and Neblett, {Wallace W.} and Tepas, {Joseph P.} and O'Neill, {James A.} and Haller, {J. Alex} and Bagwell, {Charles E.}",
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TY - JOUR

T1 - Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation

T2 - A prospective cohort study by the NICHD Neonatal Research Network

AU - Blakely, Martin L.

AU - Lally, Kevin P.

AU - McDonald, Scott

AU - Brown, Rebeccah L.

AU - Barnhart, Douglas C.

AU - Ricketts, Richard R.

AU - Thompson, W. Raleigh

AU - Scherer, L. R.

AU - Klein, Michael D.

AU - Letton, Robert W.

AU - Chwals, Walter J.

AU - Touloukian, Robert J.

AU - Kurkchubasche, Arlett G.

AU - Skinner, Michael A.

AU - Moss, R. Lawrence

AU - Hilfiker, Mary L.

AU - Langham, Max

AU - Neblett, Wallace W.

AU - Tepas, Joseph P.

AU - O'Neill, James A.

AU - Haller, J. Alex

AU - Bagwell, Charles E.

PY - 2005/6/1

Y1 - 2005/6/1

N2 - Objective: Purposes of this study were: 1) to compare mortality and postoperative morbidities (intra-abdominal abscess, wound dehiscence, and intestinal stricture) in extremely low birth weight (ELBW) infants who underwent initial laparotomy or drainage for necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP); 2) to determine the ability to distinguish NEC from IP preoperatively and the importance of this distinction on outcome measures; and 3) to evaluate the association between extent of intestinal disease determined at operation and outcome measures. Background: ELBW infants who undergo operation for NEC or IP have a postoperative, in-hospital mortality rate of approximately 50%. Whether to perform laparotomy or drainage initially is controversial. Also unknown is the importance of distinguishing NEC from IP and the current ability to make this distinction based on objective data available prior to operation. Methods: A prospective, multicenter cohort study of 156 ELBW infants at 16 neonatal intensive care units (NICU) within the NICHD Neonatal Research Network. Results: Among the 156 enrolled infants, 80 underwent initial peritoneal drainage and 76 initial laparotomy. Mortality rate was 49% (76 of 156). Ninety-six patients had a preoperative diagnosis of NEC and 60 had presumed IP. There was a high level of agreement between the presumed preoperative diagnosis and intraoperative diagnosis in patients undergoing initial laparotomy (kappa = 0.85). The relative risk for death with a preoperative diagnosis of NEC (versus IP) was 1.4 (95% confidence interval, 0.99-2.1, P = 0.052). The overall incidence of postoperative intestinal stricture was 10.3%, wound dehiscence 4.4%, and intra-abdominal abscess 5.8%, and did not significantly differ between groups undergoing initial laparotomy versus initial drainage. Conclusions: Survival to hospital discharge after operation for NEC or IP in ELBW neonates remains poor (51%). Patients with a preoperative diagnosis of NEC have a relative risk for death of 1.4 compared with those with a preoperative diagnosis of IP. A distinction can be made preoperatively between NEC and IP based on abdominal radiographic findings and the patient's age at operation. Future randomized trials that compare laparotomy versus drainage would likely benefit from stratification of treatment assignment based on preoperative diagnosis.

AB - Objective: Purposes of this study were: 1) to compare mortality and postoperative morbidities (intra-abdominal abscess, wound dehiscence, and intestinal stricture) in extremely low birth weight (ELBW) infants who underwent initial laparotomy or drainage for necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP); 2) to determine the ability to distinguish NEC from IP preoperatively and the importance of this distinction on outcome measures; and 3) to evaluate the association between extent of intestinal disease determined at operation and outcome measures. Background: ELBW infants who undergo operation for NEC or IP have a postoperative, in-hospital mortality rate of approximately 50%. Whether to perform laparotomy or drainage initially is controversial. Also unknown is the importance of distinguishing NEC from IP and the current ability to make this distinction based on objective data available prior to operation. Methods: A prospective, multicenter cohort study of 156 ELBW infants at 16 neonatal intensive care units (NICU) within the NICHD Neonatal Research Network. Results: Among the 156 enrolled infants, 80 underwent initial peritoneal drainage and 76 initial laparotomy. Mortality rate was 49% (76 of 156). Ninety-six patients had a preoperative diagnosis of NEC and 60 had presumed IP. There was a high level of agreement between the presumed preoperative diagnosis and intraoperative diagnosis in patients undergoing initial laparotomy (kappa = 0.85). The relative risk for death with a preoperative diagnosis of NEC (versus IP) was 1.4 (95% confidence interval, 0.99-2.1, P = 0.052). The overall incidence of postoperative intestinal stricture was 10.3%, wound dehiscence 4.4%, and intra-abdominal abscess 5.8%, and did not significantly differ between groups undergoing initial laparotomy versus initial drainage. Conclusions: Survival to hospital discharge after operation for NEC or IP in ELBW neonates remains poor (51%). Patients with a preoperative diagnosis of NEC have a relative risk for death of 1.4 compared with those with a preoperative diagnosis of IP. A distinction can be made preoperatively between NEC and IP based on abdominal radiographic findings and the patient's age at operation. Future randomized trials that compare laparotomy versus drainage would likely benefit from stratification of treatment assignment based on preoperative diagnosis.

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