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Current Pediatric Reviews


ISSN (Print): 1573-3963
ISSN (Online): 1875-6336

Review Article

Long Term Outcome of Infants with NEC

Author(s): Silvana Federici and Lorenzo De Biagi*

Volume 15, Issue 2, 2019

Page: [111 - 114] Pages: 4

DOI: 10.2174/1573396315666181130144925


Necrotizing enterocolitis (NEC) is an important complication for premature newborns. Infants who survive NEC have a greater possibility of poor long-term physiological and neurodevelopmental growth.

The objective of this paper is to give a comprehensive description of the long-term consequences of NEC. Despite the rise in incidence of NEC there is a scarcity of data regarding long-term outcomes of these infants that can be divided into two groups. The first group includes gastrointestinal complications that could occur in relation to the bowel disease, the surgical treatment and quality of the residual bowel. These complications are strictures and short bowel syndrome (SBS).

Intestinal strictures are a common occurance after recovery from NEC that should be investigated with a contrast study in case of suspicious clinical findings of bowel obstruction or before reversal ostomy. After this diagnostic investigation, if a stricture is detected in a symptomatic patient, resection of the affected loop of bowel with anastomosis is required. SBS is the result of a massive intestinal resection or of a dysfunctional residual bowel and it can occur in a fourth of patients affected by NEC.

The second group includes neurodevelopmental impairment and growth.

Neurodevelopmental outcomes of patients after NEC recovery have not been widely reported.

Infants with NEC is a population of patients at high risk for adverse neurodevelopmental outcomes whose cause can be multifactorial and linked to perinatal events, severity of disease, surgical treatment and its complications and hospitalization. Understanding the morbidity of NEC with a longterm follow-up would aid neonatologists and pediatric surgeons to make informed decisions in providing care for these patients. Further research on this topic is needed.

Keywords: Necrotizing enterocolitis, outcome, strictures, short bowel syndrome, neurodevelopmental impairment, growth.

Rabinowits JG, Wolf BS, Feller MR, Krasna I. Colonic changes following necrotizing enterocolitis in the newborn. Am J Roentgenol Radium Ther Nucl Med 1968; 103: 359-64.
Kosloske AM, Burstein J, Bartow SA. Intestinal obstruction due to colonic stricture following neonatal necrotizing enterocolitis. Ann Surg 1980; 192: 202-7.
Schwartz MZ, Hayden CK, Richardson CJ, et al. A prospective evaluation of intestinal stenosis following necrotizing enterocolitis. J Pediatr Surg 1982; 17: 764-70.
Lemelle JL, Schmitt M, de Miscault G, et al. Neonatal necrotizing enterocolitis: A retrospective and multicentric review of 331 cases. Acta Paediatr Suppl 1994; 396: 70-3.
Schullinger JN, Mollitt DL, Vinocur CD, et al. Neonatal necrotizing enterocolitis: Survival, management, and complications: A 25-year study. Am J Dis Child 1981; 135: 612-4.
Ricketts RR, Jerles ML. Neonatal necrotizing enterocolitis: Experience with 100 consecutive surgical patients. World J Surg 1990; 14: 600-5.
Butter A, Flageole H, Laberge JM. The changing face of surgical indications for necrotizing enterocolitis. J Pediatr Surg 2002; 37: 496-9.
Dominguez KM, Moss RL. Necrotizing enterocolitis. In: George W Holbcomb III, Patrick J Murphy, Daniel J Ostile, editors Ashcraft’s Pediatric surgery. 2014; pp. 454-73.
Houben CH, Chan KW, Mou JWC, Tam YH, Lee KH. Management of intestinal strictures post conservative treatment of necrotizing enterocolitis: The long term outcome. J Neonatal Surg 2016; 5: 28.
Schwartz MZ, Richardson CJ, Hayden CK, et al. Intestinal stenosis following successful medical management of necrotizing enterocolitis. J Pediatr Surg 1980; 15: 890-9.
Tonkin IL, Bjelland JC, Hunter TB, et al. Spontaneous resolution of colonic strictures caused by necrotizing enterocolitis: Therapeutic implications. AJR Am J Roentgenol 1978; 130: 1077-81.
Hartman GE, Drugas GT, Shochat SJ. Post-necrotizing enterocolitis strictures presenting with sepsis or perforation: Risk of clinical observation. J Pediatr Surg 1988; 23: 562-6.
Born M, Holgersen LO, Shahrivar F, Stanley-Brown E, Hilfer C. Routine contrast enemas for diagnosing and managing strictures following non operative treatment of necrotizing enterocolitis. J Pediatr Surg 1985; 20(4): 461-3.
Grant CN, Golden JM, Anselmo DM. Routine contrast enema is not required for all infants prior to ostomy reversal: A 10-year single-center experience. J Pediatr Surg May 2016; 32(5): 465-70.
Wiland EL, South AP, Kraus SJ, Meizer-Derr S. Utility of gastrointestinal fluoroscopic studies in detecting stricture after neonatal necrotizing enterocolitis. JPGN 2014; 6(59): 789-94.
Wilmore DW. Factors correlating with a successful outcome following extreme intestinal resection in newborn infants. J Pediatr 1972; 80: 88-95.
Andorsky DJ, Lund DP, Lillehei CW, et al. Nutritional and other postoperative management of meonates with short bowel syndrome correlates with clinical outcomes. J Pediatr 2001; 139: 27-33.
Fitzgibbons S, Ching YA, Valim C, et al. Relationship between serum citrulline levels and progression to parenteral nutrition independence in children with short bowel syndrome. J Pediatr Surg 2009; 44: 928-32.
Gutierrez IM, Kang KH, Jaksic T. Neontal short bowel syndrome. Seminars in Fetal & Neonatal Medicine 16(2011): 157-63.
Sonntag J, Grimmer I, Scholz T, Metze B, Wit J, Obladen M. Growth and neurodevelopmental outcome in very low birth weight infants with necrotizing enterocolitis Acta Pediatr 2000.
Castro L, Yolton K, Haberman B, et al. Bias in reported neurodevelopmental outcomes among extremely low birth weight survivors. Pediatrics 2004; 114: 404-10.
Hintz SR, Kendrick DE, Stoll BJ, et al. NICHD Neonatal Research Network Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis. Pediatrics 2005; 115(3): 696-703.
Simon NP. Follow-up for infants with necrotizing enterocolitis. Clin Perinatol 1994; 21: 411.
Ta BDP, Roze E, Van Braeckel KNJA, et al. Long-term Neurodevelopmental Impairment in neonates surgically treated for necrotizing neterocolitis: Enterostomy associated with a worse outcome. Eur J Pediatr Surg 2011; 21: 5.

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