Risk Factors for 30-day Mortality in Patients with Surgically Treated Necrotizing Enterocolitis: A Multicenter Retrospective Cohort Study

Adinda G.H. Pijpers; Ceren Imren; Otis C. van Varsseveld; Laurens D. Eeftinck Schattenkerk; Claudia M.G. Keyzer-Dekker; Jan B.F. Hulscher; Elisabeth M.W. Kooi; Chris H.P. van den Akker; Joost van Schuppen; H. Rob Taal; Jos W.R. Twisk; Joep P.M. Derikx; Marijn J. Vermeulen

doi:10.1055/a-2536-4757

European Journal of Pediatric Surgery, Inhaltsverzeichnis

CC BY 4.0 · Eur J Pediatr Surg 2025; 35(04): 332-340
DOI: 10.1055/a-2536-4757

Original Article

Risk Factors for 30-day Mortality in Patients with Surgically Treated Necrotizing Enterocolitis: A Multicenter Retrospective Cohort Study

Adinda G.H. Pijpers ‡^*

¹Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

²Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

³Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands

,

Ceren Imren‡^*

⁴Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands

,

Otis C. van Varsseveld

⁵Department of Surgery, Division of Pediatric Surgery, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands

,

Laurens D. Eeftinck Schattenkerk

¹Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

²Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

³Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands

,

Claudia M.G. Keyzer-Dekker

⁴Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands

,

Jan B.F. Hulscher

⁵Department of Surgery, Division of Pediatric Surgery, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands

,

Elisabeth M.W. Kooi

⁶Department of Pediatrics, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands

,

Chris H.P. van den Akker

²Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

³Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands

⁷Department of Pediatrics, Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

,

Joost van Schuppen

⁸Department of Radiology and Nuclear Medicine, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

,

H. Rob Taal

⁹Department of Neonatal and Paediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands

,

Jos W.R. Twisk

¹⁰Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands

,

Joep P.M. Derikx

¹Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

²Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

³Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands

,

Marijn J. Vermeulen

⁹Department of Neonatal and Paediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands

› Institutsangaben

Abstract

Purpose

Necrotizing enterocolitis (NEC) is a leading cause of death in very preterm born infants. The most severe variant is NEC totalis (NEC-T), where necrosis of the small intestines is so extensive that curative care is often withdrawn. Mortality and NEC-T are difficult to predict before surgery, complicating counseling and decision-making. This study's aim was to identify preoperative risk factors for overall 30-day mortality and NEC-T in preterm born infants with surgical NEC.

Methods

This multicenter retrospective cohort study included preterm born infants (<35 weeks) surgically treated for NEC between 2008 and 2022. NEC-T was defined as necrosis of the majority of small intestine, leading to a surgical open-close procedure without curative treatment. Preoperative risk factors for 30-day postoperative mortality, NEC-T, and mortality without NEC-T were assessed using multivariable logistic regression analyses.

Results

Among the 401 patients included, the 30-day mortality rate was 34.2% (137/401), of which 18.7% (75/401) involved NEC-T. Significant risk factors for mortality were male sex (odds ratio [OR]: 2.53; 95% confidence interval [CI]: 1.54–4.16), lower birthweight (OR: 0.91; 95% CI: 0.86–0.96/100 g), portal venous gas (PVG) on abdominal radiograph (OR: 1.89; 95% CI: 1.11–3.20), need for cardiovascular support between NEC diagnosis and surgery (OR: 3.26; 95% CI: 2.02–5.24), and shorter time between diagnosis and surgery (OR: 0.74; 95% CI: 0.65–0.84). Similar risk factors were found for NEC-T. In patients without NEC-T, the need for cardiovascular support (OR: 2.33; 95% CI: 1.33–4.09) and time between diagnosis and surgery (OR: 0.77; 95% CI: 0.64–0.91) were significant.

Conclusion

Male sex, lower birthweight, PVG, cardiovascular support, and a short interval between NEC diagnosis and surgery are preoperative risk factors for 30-day mortality and NEC-T. Preoperative cardiovascular support and a shorter time interval between diagnosis and surgery are also risk factors for mortality without NEC-T.

Level of evidence

II

Keywords

NEC totalis - portal venous gas - neonates - cardiovascular support

Volltext

Referenzen

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