Evidence map›Paper›PMID 40407731›Full record

ArticleBJS open2025

Surgical outcomes for necrotizing enterocolitis in Dutch infants born before 26 weeks' gestation.

Otis C van Varsseveld, Adinda G H Pijpers, Ceren Imren, Joep P M Derikx, Chris H P van den Akker, Joost van Schuppen, Claudia M G Keyzer-Dekker, Marijn J Vermeulen, Maarten Schurink, Maud Y A Lindeboom and 2 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BJS open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Otis C van VarsseveldDepartment of Surgery, Division of Pediatric Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.ORCID 0000-0001-8764-7744
Adinda G H PijpersDepartment of Pediatric Surgery, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands.
Ceren ImrenDepartment of Pediatric Surgery, Sophia Children's Hospital, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands.
Joep P M DerikxDepartment of Pediatric Surgery, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands.
Chris H P van den AkkerDepartment of Pediatrics-Neonatology, Emma Children's Hospital, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Centers, University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands.ORCID 0000-0002-5494-730X
Joost van SchuppenDepartment of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Claudia M G Keyzer-DekkerDepartment of Pediatric Surgery, Sophia Children's Hospital, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands.
Marijn J VermeulenDepartment of Pediatric and Neonatal Intensive Care, Division of Neonatology, Sophia Children's Hospital, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands.
Maarten SchurinkDepartment of Pediatric Surgery, Amalia Children's Hospital, Radboudumc, Radboud University, Nijmegen, the Netherlands.
Maud Y A LindeboomDepartment of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
Elisabeth M W KooiDivision of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Jan B F HulscherDepartment of Surgery, Division of Pediatric Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn infants born at < 26 weeks of gestational age (wGA) who develop necrotizing enterocolitis (NEC), medical and ethical considerations about whether surgery is the optimal treatment are complicated by a lack of group-specific outcome data. This study investigated nationwide 30-day mortality, surgical complications, and preoperative mortality risk factors in infants born at < 26 wGA who underwent surgery during the active phase of NEC.

methodsThis retrospective nationwide multicentre study included all infants born at < 26 wGA undergoing surgery for Bell's stage II/III NEC in the Netherlands between 2008 and 2022, regardless of outcome. Severe NEC was defined as Bell's stage III (confirmed by laparotomy and/or leading to death). The primary outcome was postoperative 30-day mortality. The incidence of major postoperative complications (Clavien-Madadi III-IV) was determined after excluding infants undergoing open-close procedures for massive bowel necrosis. Potential risk factors for death after surgery were assessed using multivariable logistic regression.

resultsOf 288 infants with NEC Bell's stage ≥ II, 80 (27.8%) survived without surgery, 66 (22.9%) died before laparotomy, and 142 (49.3%) underwent laparotomy. In 142 surgically treated infants with severe NEC (57.0% male), the median gestational age was 25 + 0 (range 23 + 6 to 25 + 6) weeks + days, the median birthweight was 750 (range 485-1070) g, and the median age at surgery was 14 (range 2-66) days. Primary open-close surgery was performed in 34 of 142 infants (23.9%). In the remaining 108 infants, surgical management included stoma creation (63.0%), primary anastomosis (27.8%), or both (9.3%). Overall, the 30-day mortality rate among 142 infants was 47.2% (67 deaths). Death occurred after a primary or second-look open-close procedure in 37 infants, after multiorgan failure in 17, and from other causes in the remaining 13. After excluding 37 infants who died after open-close procedures, 30-day complications occurred in 23 (21.9%) of 105 surgically treated infants. There were 29 events in total, including reoperation for bowel perforation (5, 17%) or anastomotic leak/stenosis (5, 17%). Regression analysis identified no risk factors for 30-day mortality.

conclusionThe 30-day mortality rate was 47.2% in infants born at < 26 wGA undergoing NEC surgery, most of whom died after an open-close procedure. Another 21.9% of infants experienced major complications.

Indexed as

Enterocolitis, NecrotizingInfant, Premature, DiseasesPostoperative ComplicationsFemaleGestational AgeHumansInfantInfant, NewbornInfant, PrematureLaparotomyMaleNetherlandsRetrospective StudiesRisk FactorsTreatment Outcome

Identifiers

PMID40407731
PMCPMC12101056

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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.