Evidence map›Paper›PMID 39448869›Full record

ArticleJournal of perinatology : official journal of the California Perinatal Association2025

Necrotizing enterocolitis following spontaneous intestinal perforation in very low birth weight neonates.

Goeto Dantes, Olivia A Keane, Swathi Raikot, Louis Do, Savanah Rumbika, Zhulin He, Amina M Bhatia

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Article in Journal of perinatology : official journal of the California Perinatal Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Goeto DantesDepartment of Surgery, Emory University, Atlanta, GA, USA. gdantes@emory.edu.ORCID http://orcid.org/0000-0003-1683-9786
Olivia A KeaneDepartment of Surgery, Emory University, Atlanta, GA, USA.
Swathi RaikotDivision of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Louis DoEmory University School of Medicine, Emory University, Atlanta, GA, USA.
Savanah RumbikaEmory University School of Medicine, Emory University, Atlanta, GA, USA.
Zhulin HePediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.ORCID http://orcid.org/0000-0002-5852-8065
Amina M BhatiaDivision of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeNecrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are severe gastrointestinal complications of prematurity. The clinical presentation and treatment of NEC and SIP (peritoneal drain vs laparotomy) can overlap; however, the pathogenesis is distinct. Therefore, a patient initially treated for SIP can subsequently develop NEC. This phenomenon has only been described in case reports, and no risk factor evaluation exists. We evaluate clinical characteristics, risk factors, and outcomes of patients treated for a distinct episode of NEC after SIP.

methodsWe performed a retrospective review of very low birth weight (<1500 g) neonates who presented with pneumoperitoneum between 07/2004 and 09/2022. Data was obtained from two separate neonatal intensive care units that were part of the same institution. Patients with an initial preoperative, intraoperative, or pathological diagnosis of NEC were excluded. Patients with an intraoperative diagnosis of SIP or preoperative diagnosis of SIP successfully treated with a peritoneal drain (PD) were evaluated. Patients subsequently treated (medically or surgically) for NEC after SIP were then compared to SIP-alone patients. Clinical characteristics included demographics, gestational age (GA), birth weight (BW), perinatal risk factors (chorioamnionitis, steroids, indomethacin), postoperative feeding regimen, and length of stay (LOS) were compared.

resultsOf the 278 patients included, 31 (11.2%) patients had NEC after SIP. There was no difference in GA (25 weeks vs 25 weeks, p = 0.933) or BW (760 g vs 735 g, p = 0.370) between NEC after SIP vs SIP alone cohorts, respectively. Twenty (64%) of NEC after-SIP patients were previously treated with LP. NEC after SIP occurred with a median onset of 56 days. Pneumatosis was the most frequent (81%) presenting symptom and 12 (39%) patients had hematochezia. Four (12.9%) patients required LP for NEC and all had NEC intraoperatively and on pathology. A majority (77.4%) of patients were on breast milk (BM) at time of NEC diagnosis. NEC after SIP patients had lower maternal age at delivery (29.0 vs 25.0, p = 0.055) and the incidence of NEC after LP (primary or failed drain) was higher than PD alone (16.7% vs 6.2%, p = 0.007). NEC after SIP patients had longer LOS (135 vs 81, p < 0.001).

conclusionWe report an 11.2% incidence of NEC at a median of 56 days following successful treatment of SIP, resulting in increased LOS. SIP patients are a high-risk cohort and protocols to prevent this phenomenon should be investigated.

Indexed as

Enterocolitis, NecrotizingInfant, Premature, DiseasesInfant, Very Low Birth WeightIntestinal PerforationDrainageFemaleGestational AgeHumansInfant, NewbornMalePneumoperitoneumRetrospective StudiesRisk Factors

Identifiers

PMID39448869

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.