Abstract
Necrotizing enterocolitis (NEC) remains the most threatening gastrointestinal complication of prematurity leading to high mortality, morbidity and cost. Common complications of NEC include neurodevelopmental delay, failure to thrive, gastrointestinal problems including strictures and adhesions, cholestasis, short bowel syndrome with or without intestinal failure that can be difficult to manage. Infants who develop NEC benefit from close follow-up for early diagnosis and treatment of complications. Those who present with severe complications such as intestinal failure benefit from a multidisciplinary approach involving careful assessment and treatment. Studies done so far are limited in providing a long-term prognosis. Here we review some of these complications. More studies with a longer follow-up period are needed to better understand the later comorbidities that develop in babies with NEC.
Keywords: Necrotizing enterocolitis, intestinal failure, complications, adhesions, cholestasis, spontaneous intestinal perforation.
[2]
Cacho NT, Parker LA, Neu J. Necrotizing Enterocolitis and Human Milk Feeding: A Systematic Review. Clin Perinatol 2017; 44(1): 49-67.
[3]
Patel RM, Kandefer S, Walsh MC, et al. Causes and Timing of Death in Extremely Premature Infants from 2000 through 2011. N Engl J Med 2015; 372(4): 331-40.
[4]
Ree IMC, Smits-Wintjens VEHJ, Rijntjes-Jacobs EGJ, et al. Necrotizing enterocolitis in small-for-gestational-age neonates: a matched case-control study. Neonatology 2014; 105(1): 74-8.
[5]
Zani A, Pierro A. Necrotizing enterocolitis: controversies and challenges. F1000Research 2015; 4: 1373.
[6]
Cuna A, Sampath V. Genetic alterations in necrotizing enterocolitis. Semin Perinatol 2017; 41(1): 61-9.
[7]
Bell MJ, Shackelford P, Feigin RD, Ternberg JL, Brotherton T. Epidemiologic and bacteriologic evaluation of neonatal necrotizing enterocolitis. J Pediatr Surg 1979; 14(1): 1-4.
[8]
Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33(1): 179-201.
[9]
Battersby C, Longford N, Costeloe K, Modi N. Development of a gestational age–specific case definition for neonatal necrotizing enterocolitis. JAMA Pediatr 2017; 171(3): 256.
[10]
Gordon PV, Swanson JR, MacQueen BC, Christensen RD. A critical question for NEC researchers: Can we create a consensus definition of NEC that facilitates research progress? Semin Perinatol 2017; 41(1): 7-14.
[11]
Gephart SM, Gordon PV, Penn AH, et al. Changing the paradigm of defining, detecting, and diagnosing NEC: Perspectives on Bell’s stages and biomarkers for NEC. Semin Pediatr Surg 2018; 27(1): 3-10.
[12]
Mowitz ME, Dukhovny D, Zupancic JAF. The cost of necrotizing enterocolitis in premature infants. Semin Fetal Neonatal Med 2018; 23(6): 416-9.
[13]
Hull MA, Fisher JG, Gutierrez IM, et al. Mortality and management of surgical necrotizing enterocolitis in very low birth weight neonates: a prospective cohort study. J Am Coll Surg 2014; 218(6): 1148-55.
[14]
Stey A, Barnert ES, Tseng C-H, et al.
Outcomes and costs of surgical treatments of necrotizing enterocolitis. pediatrics 2015; 135(5): e1190-7.
[15]
Tashiro J, Wagenaar AE, Perez EA, Sola JE. Peritoneal drainage is associated with higher survival rates for necrotizing enterocolitis in premature, extremely low birth weight infants. J Surg Res 2017; 218: 132-8.
[16]
Shah TA, Meinzen-Derr J, Gratton T, et al. Hospital and neurodevelopmental outcomes of extremely low-birth-weight infants with necrotizing enterocolitis and spontaneous intestinal perforation. J Perinatol 2012; 32(7): 552-8.
[17]
Shah J, Singhal N, da Silva O, et al. Intestinal perforation in very preterm neonates: risk factors and outcomes. J Perinatol 2015 Aug 30;; 35(8): 595-600.
[18]
Wadhawan R, Oh W, Hintz SR, et al. Neurodevelopmental outcomes of extremely low birth weight infants with spontaneous intestinal perforation or surgical necrotizing enterocolitis. J Perinatol 2014; 34(1): 64-70.
[19]
Fullerton BS, Hong CR, Velazco CS, et al. Severe neurodevelopmental disability and healthcare needs among survivors of medical and surgical necrotizing enterocolitis: A prospective cohort study. J Pediatr Surg 2018; 53(1): 101-7.
[20]
Murthy K, Yanowitz TD, DiGeronimo R, et al. Short-term outcomes for preterm infants with surgical necrotizing enterocolitis. J Perinatol 2014; 34(10): 736-40.
[21]
Sato M, Hamada Y, Kohno M, et al. Neonatal gastrointestinal perforation in Japan: A nationwide survey. Pediatr Surg Int 2017; 33(1): 33-41.
[22]
Youn YA, Kim E-K, Kim SY. Necrotizing Enterocolitis among Very-Low-Birth-Weight Infants in Korea. J Korean Med Sci 2015; 30: S75-80.
[23]
Elfvin A, Dinsdale E, Wales PW, Moore AM. Low birthweight, gestational age, need for surgical intervention and gram-negative bacteraemia predict intestinal failure following necrotising enterocolitis. Acta Paediatr 2015; 104(8): 771-6.
[24]
Federici SDE, Biagi L, Straziuso S, et al. Multicenter retrospective study on management and outcome of newborns affected by surgical necrotizing enterocolitis. Minerva Chir 2017; 72(3): 183-7.
[25]
Durell J, Hall NJ, Drewett M, Paramanantham K, Burge D. Emergency laparotomy in infants born at <26 weeks gestation: a neonatal network-based cohort study of frequency, surgical pathology and outcomes. Arch Dis Child Fetal Neonatal Ed 2017; 102(6): F504-7.
[26]
Allin BSR, Long A-M, Gupta A, Lakhoo K, Knight M. One-year outcomes following surgery for necrotising enterocolitis: A UK-wide cohort study. Arch Dis Child Fetal Neonatal Ed 2018; 103(5): F461-6.
[27]
Karila K, Anttila A, Iber T, Pakarinen M, Koivusalo A. Outcomes of surgery for necrotizing enterocolitis and spontaneous intestinal perforation in Finland during 1986–2014. J Pediatr Surg 2018; 53(10): 1928-32.
[28]
Luttikhuizen dos Santos ES, de Kieviet JF, Königs M, van Elburg RM, Oosterlaan J. Predictive value of the Bayley Scales of Infant Development on development of very preterm/very low birth weight children: A meta-analysis. Early Hum Dev 2013; 89(7): 487-96.
[29]
Burakevych N, Mckinlay CJD, Alsweiler JM, Wouldes TA, Harding JE. Bayley-III motor scale and neurological examination at 2 years do not predict motor skills at 4.5 years. Dev Med Child Neurol 2017; 59(2): 216-23.
[30]
Spencer-Smith MM, Spittle AJ, Lee KJ, Doyle LW, Anderson PJ. Bayley-III Cognitive and Language Scales in Preterm Children. Pediatrics 2015; 135(5): e1258-65.
[31]
Potharst ES, Houtzager BA, van Sonderen L, et al. Prediction of cognitive abilities at the age of 5 years using developmental follow-up assessments at the age of 2 and 3 years in very preterm children. Dev Med Child Neurol 2012; 54(3): 240-6.
[32]
Merhar SL, Ramos Y, Meinzen-Derr J, Kline-Fath BM. Brain magnetic resonance imaging in infants with surgical necrotizing enterocolitis or spontaneous intestinal perforation versus medical necrotizing enterocolitis. J Pediatr 2014; 164(2): 410-2.e1.
[33]
Jiang ZD, Wang C, Chen C. Neonatal necrotizing enterocolitis adversely affects neural conduction of the rostral brainstem in preterm babies. Clin Neurophysiol 2014; 125(11): 2277-85.
[34]
Ping LL, Jiang ZD. Comparison of brainstem auditory evoked response at different click rates between preterm babies after neonatal necrotizing enterocolitis and healthy preterm babies. Neonatology 2014; 106(4): 317-22.
[35]
Pike K, Brocklehurst P, Jones D, et al. Outcomes at 7 years for babies who developed neonatal necrotising enterocolitis: The ORACLE Children Study. Arch Dis Child Fetal Neonatal Ed 2012; 97(5): F318-22.
[36]
Allendorf A, Dewitz R, Weber J, Bakthiar S, Schloesser R, Rolle U. Necrotizing enterocolitis as a prognostic factor for the neurodevelopmental outcome of preterm infants - match control study after 2 years. J Pediatr Surg 2018; 53(8): 1573-7.
[37]
Ganapathy V, Hay JW, Kim JH, Lee ML, Rechtman DJ. Long term healthcare costs of infants who survived neonatal necrotizing enterocolitis: A retrospective longitudinal study among infants enrolled in Texas Medicaid. BMC Pediatr 2013 Aug 20; 13: 127.
[38]
Kidokoro H, Anderson PJ, Doyle LW, Woodward LJ, Neil JJ, Inder TE. Brain injury and altered brain growth in preterm infants: predictors and prognosis. Pediatrics 2014; 134(2): e444-53.
[39]
Zhang H, Chen J, Wang Y, Deng C, Li L, Guo C. Predictive factors and clinical practice profile for strictures post-necrotising enterocolitis. Medicine (Baltimore) 2017; 96(10)e6273
[40]
Gaudin A, Farnoux C, Bonnard A, et al. Necrotizing enterocolitis (NEC) and the risk of intestinal stricture: the value of C-reactive protein. PLoS One 2013; 8(10)e76858
[41]
Burnand KM, Zaparackaite I, Lahiri RP, et al. The value of contrast studies in the evaluation of bowel strictures after necrotising enterocolitis. Pediatr Surg Int 2016; 25 ;32(5): 465-70.
[42]
Heida FH, Loos MHJ, Stolwijk L, et al. Risk factors associated with postnecrotizing enterocolitis strictures in infants. J Pediatr Surg 2016; 51(7): 1126-30.
[43]
Lakshminarayanan B, Hughes-Thomas AO, Grant HW. Epidemiology of adhesions in infants and children following open surgery. Semin Pediatr Surg 2014; 23(6): 344-8.
[44]
Fredriksson F, Christofferson RH, Lilja HE. Adhesive small bowel obstruction after laparotomy during infancy. Br J Surg 2016; 103(3): 284-9.
[45]
Amin SC, Pappas C, Iyengar H, Maheshwari A. Short Bowel Syndrome in the NICU. Clin Perinatol 2013; 40(1): 53-68.
[46]
Khan FA, Mitchell PD, Fisher JG, et al. Magnitude of surgical burden associated with pediatric intestinal failure: A multicenter cohort analysis. J Pediatr Surg 2014; 49(12): 1795-8.
[47]
Squires RH, Duggan C, Teitelbaum DH, et al. Natural History of Pediatric Intestinal Failure: Initial Report from the Pediatric Intestinal Failure Consortium. J Pediatr 2012; 161(4): 723-8.e2.
[48]
Sparks EA, Khan FA, Fisher JG, et al. Necrotizing enterocolitis is associated with earlier achievement of enteral autonomy in children with short bowel syndrome. J Pediatr Surg 2016; 51(1): 92-5.
[49]
Khan FA, Squires RH, Litman HJ, et al. Predictors of enteral autonomy in children with intestinal failure: A multicenter cohort study. J Pediatr 2015; 167(1): 290-34.e1.
[50]
Demehri FR, Stephens L, Herrman E, et al. Enteral autonomy in pediatric short bowel syndrome: Predictive factors one year after diagnosis. J Pediatr Surg 2015; 50(1): 131-5.
[51]
Wiland EL, South AP, Kraus SJ, Meinzen-Derr J. Utility of gastrointestinal fluoroscopic studies in detecting stricture after neonatal necrotizing enterocolitis. J Pediatr Gastroenterol Nutr 2014; 59(6): 789-94.
[52]
Hong CR, Fullerton BS, Mercier CE, et al. Growth morbidity in extremely low birth weight survivors of necrotizing enterocolitis at discharge and two-year follow-up. J Pediatr Surg 2018; 53(6): 1197-202.
Related Books
Common Pediatric Diseases: an Updated Review
Article Metrics
110
33
1