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Necrotizing enterocolitis totalis: High mortality in the absence of an aggressive surgical approach.

Abstract：

BACKGROUND:Necrotizing enterocolitis is the leading case of gastrointestinal-related morbidity in premature infants. Necrotizing enterocolitis totalis is an aggressive form of necrotizing enterocolitis, which has traditionally been managed with comfort care. Recent advances in management of short bowel syndrome have resulted in some reported long-term survival. METHODS:Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies that reported outcomes in children with necrotizing enterocolitis totalis were identified. The definition of necrotizing enterocolitis totalis was captured along with length of follow-up, patient demographics, and outcomes. RESULTS:A total of 766 articles were screened, of which 166 were selected for full article review. Of these, 32 articles included data on 414 patients with necrotizing enterocolitis totalis. In the majority of studies (52%), necrotizing enterocolitis totalis was not defined. Aggressive surgical therapy (defined as bowel resection or fecal diversion) was undertaken in 32 patients (7.7%), with a mortality rate of 68.8%. In contrast, nonaggressive surgical therapy was undertaken in 382 patients (92.3%), and the mortality in these patients was 95%. Long-term outcomes for necrotizing enterocolitis totalis survivors, such as length of time on parenteral nutrition, progression to liver and/or small bowel transplant, and quality of life, were not reported. CONCLUSION:We found that there is no accepted definition of necrotizing enterocolitis totalis. Aggressive surgical therapy is rarely pursued, which likely drives the overall high mortality rate. This study underscores the importance of standardizing the definition of necrotizing enterocolitis totalis and capturing short and long-term outcomes prospectively. With more aggressive surgical therapy, more infants are likely to survive this abdominal catastrophe, which was once thought to be uniformly fatal.

journal_name

Surgery

journal_title

Surgery

authors

Dukleska K,Devin CL,Martin AE,Miller JM,Sullivan KM,Levy C,Prestowitz S,Flathers K,Vinocur CD,Berman L

doi

10.1016/j.surg.2019.03.005

subject

Has Abstract

pub_date

2019-06-01 00:00:00

pages

1176-1181

issue

eissn

0039-6060

issn

1532-7361

pii

S0039-6060(19)30127-8

journal_volume

165

pub_type

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Necrotizing enterocolitis totalis: High mortality in the absence of an aggressive surgical approach.