Indications To Surgery In Necrotising Enterocolitis Of Extremely Low Birth Weight Prematures. Can We Do Better?

Abstract

Necrotising enterocolitis is one of the major complications affecting these patients, often leading to an unfavorable outcome despite surgical treatment, because of intestinal necrosis and sepsis. Early stages of NEC are treated conservatively, but understanding progression of the disease and optimal timing of surgery is often challenging. The indications for surgery include the presence of pneumoperitoneum, indicating perforation of the intestine, clinical deterioration despite maximal medical treatment, abdominal mass with intestinal obstruction, and development of intestinal stricture. Relative indications include fixed dilated intestinal loop, presence of portal gas, thrombocytopenia, and rapid fall in platelet count [4,5]. Although relative indications to surgery may apply, the absolute indication to surgery in prematures with NEC is Bell stage III, which is characterized by the aforementioned clinical features of advanced disease and progressive deterioration. This condition involves high fatality. Patients who undergo surgery are more likely to die than the ones who do not [6]. Gangrene and perforation are known to be associated with 30% and 64% postoperative mortality rate respectively [7] and the outcome of affected infants is influenced by the length of necrotic bowel [8].