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26 - Necrotizing enterocolitis

from Part IV - Abdomen

Published online by Cambridge University Press:  08 January 2010

By
Marion C. W. Henry  and
R. Lawrence Moss
Edited by
Mark D. Stringer ,
Keith T. Oldham  and
Pierre D. E. Mouriquand
Marion C. W. Henry
Affiliation:
Department of Pediatric Surgery, Yale University School of Medicine, New Haven, CT, USA
R. Lawrence Moss
Affiliation:
Department of Pediatric Surgery, Yale University School of Medicine, New Haven, CT, USA
Mark D. Stringer
Affiliation:
University of Otago, New Zealand
Keith T. Oldham
Affiliation:
Children's Hospital of Wisconsin
Pierre D. E. Mouriquand
Affiliation:
Debrousse Hospital, Lyon
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Summary

Introduction

For more than 30 years, necrotizing enterocolitis (NEC) has been the most common surgical emergency in the neonatal intensive care unit (NICU). Despite decades of clinical advances and research, the management of NEC continues to pose a significant challenge to the pediatric surgeon. Currently, NEC is the major cause of death for all neonates undergoing surgery with a surgical mortality rate of 20–60%. The mortality from this disease is greater than that from all of the congenital anomalies of the gastrointestinal tract combined. Infants who do survive may be plagued by the chronic condition of short-bowel syndrome, with its associated complications of total parenteral nutrition and the possible need for liver and/or intestinal transplantation. Additionally, infants surviving necrotizing enterocolitis may have significant long-term gastrointestinal, growth and neurodevelopmental sequelae.

Epidemiology

Necrotizing enterocolitis affects 1–3 in 1000 live births and up to 8% of NICU admissions. In 2001, NEC was the tenth leading cause of neonatal deaths. As advances in neonatology and the modern intensive care unit have led to the increased survival of smaller and younger infants, the number of babies at risk for NEC and, therefore, the incidence has increased.

During the last 20 years, the infant mortality rate attributable to NEC increased from an average of 11.5 per 100000 live births in the early 1980s to an average of 12.3 deaths per 100 000 live births during 1990–1992.

Type
Chapter
Information
Pediatric Surgery and Urology
Long-Term Outcomes
 , pp. 329 - 350
Publisher: Cambridge University Press
Print publication year: 2006

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