Short summary

The objective of this study is to identify and calculate/estimate the incidence of surgical complications in premature infants with NEC with special focus on enterostomy related complications.

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Rationale

Necrotizing enterocolitis (NEC) is a condition primarily seen in premature infants where portions of the bowel undergo necrosis. Initial symptoms indicating NEC are feeding intolerance, increased gastric residuals, abdominal distension and bloody stools. Symptoms may progress rapidly to abdominal discoloration with intestinal perforation, peritonitis and systemic hypotension. NEC is typically seen in premature infants and both low gestational age (GA) and low birth weight are known risk factors.

Surgical intervention is necessary in 20-60 % of NEC cases. The postoperative period is challenged by complications and prolonged recovery and 20-30 % of patients may need secondary surgery. Progressive intestinal ischemia is the most feared complication after surgery for NEC. The postoperative problems include treatment of peritonitis, timing and amount of enteral nutrition, and surveillance prior to reoperation. The latter is especially important since no paraclinical investigation has proven to be of significant use in postoperative surveillance and decision-making. Thus, the decision to re-operate relies primarily on the clinical development and findings.

Resection and stoma formation is considered the safest surgical method. But primary anastomosis has proven to be an option, even in extreme low body weight (ELBW) infants. Stoma formation does not always provide a straightforward solution. It involves problems with poor weight gain, electrolyte imbalance due to high intestinal output, stenosis, prolapse and excoriation of the surrounding skin. Restoration of intestinal continuity involves a second anesthesia and surgery, and metabolic or functional problems may demand early surgery before the child has recovered from the acute phase. The incidence of complications in infants with enterostomies for NEC may be as high as 68%. 

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Description of the cohort

All cases of NEC during the last 20 years will be identified and studied. Every case of NEC undergoing surgery in the last 20 years will be included.

Data and biological material

Cases will be identified by ICD-10 diagnoses through the Danish National Registry of Patients (DNRP).

In every case of NEC surgery, the resected segments of intestine undergo histological examination at the Department of Pathology. Each case will have a specific histological diagnosis and entered into the Pathobank. This study will use data from the Department of Pathology to identify every case of surgically treated NEC at Odense University Hospital in the last 20 years.

The two registries will be cross-checked, as to assure that all cases can be identified.

Collaborating researchers and departments

Department of Surgery, Odense University Hospital

• Jens Kristian Baelum, MD
• Mark Bremholm Ellebaek, MD, PhD
• Professor Niels Qvist, MD