Does timing of surgery make the difference in outcomes for preterm infants with NEC?

Infants with surgical NEC are managed with either peritoneal drainage (PD) or laparotomy (LAP) as the initial treatment strategy. Most infants with NEC, who ultimately require surgical care, are first managed medically, the duration of which varies across centers. The timing of surgical invention can influence clinical outcomes well beyond the acute phase of the illness. The evidence for the optimal timing for LAP in preterm infants with surgical NEC is not available. In this commentary, we highlight the evidence surrounding the impact of timing of laparotomy on the clinical outcomes in preterm infants with surgical NEC from both our own study and from information collected from a search of the databases PubMed, EMBASE, and Scopus. Most studies report mixed outcomes regarding the impact of surgical timing on clinical outcomes in preterm infants with NEC. Improved imaging methods capable of assessing the intestinal health in real time may greatly advance care and focus the temporal framework for surgical interventions. IMPACT: The timing of surgery in preterm infants impacts the surgical NEC associated morbidities. The optimal timing for surgery in preterm infants with surgical NEC needs further studies. Assessing intestinal health preoperatively in real time, as well as intraoperatively, using a combination of statistical models and non-invasive imaging, has the great potential to improve acute and long-term outcomes for infants suffering from NEC.