Augusto Zani1, Simon Eaton2, Prem Puri3, Risto Rintala4, Marija Lukac5, Pietro Bagolan6, Joachim F Kuebler7, Michael E Hoellwarth8, Rene Wijnen9, Juan Tovar10, Agostino Pierro11. 1. Department of Pediatric Surgery, Sapienza University of Rome, Rome, Italy. 2. Department of Paediatric Surgery, University College London, Institute of Child Health, London, United Kingdom. 3. Department of Pediatric Surgery, National Children's Research Centre, Dublin, Ireland. 4. Department of Paediatric Surgery, Hospital for Children and Adolescents, Helsinki, Finland. 5. Department of Pediatric Surgery, Faculty of Medicine, University Children's Hospital, Belgrade, Serbia. 6. Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy. 7. Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria. 8. Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany. 9. Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen,The Netherlands. 10. Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain. 11. Department of Paediatric Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
Abstract
AIM: The aim of this study is to define patterns in the management of necrotizing enterocolitis (NEC). METHODS: A total of 80 delegates (81% senior surgeons) from 29 (20 European) countries completed a survey at the European Pediatric Surgeons' Association 2013 annual meeting. RESULTS: Overall, 59% surgeons work in centers where>10 cases of NEC are treated per year. DIAGNOSIS: 76% surgeons request both anteroposterior and lateral abdominal X-rays, which are performed at regular intervals by 66%; 50% surgeons also request Doppler ultrasonography; most frequently used biochemical markers are platelets (99% of surgeons), C-reactive protein (90%), and white cell count (83%). Laparoscopy is performed for diagnosis and/or treatment of NEC by only 8% surgeons. Overall, 43% surgeons reported being able to diagnose focal intestinal perforation preoperatively. Medical NEC: medical NEC is managed by surgical and neonatal teams together in most centers (84%). Most surgeons (67%) use a combination of two (51%) or three (48%) antibiotics for more than 7 days, and keep patients nil by mouth for 7 (41%) or 10 (49%) days. Surgical NEC: In extremely low-birth-weight infants (< 1,000 g) with intestinal perforation, 27% surgeons opt for primary peritoneal drainage (PPD) as definitive treatment. Overall, 67% think that peritoneal drainage is important for stabilization and transport. At laparotomy, treatments vary according to NEC severity. About 75% surgeons always close the abdomen, and 29% leave a patch to prevent compartment syndrome. POSTOPERATIVE MANAGEMENT: Infants are kept nil by mouth for 5 to 7 days by 46% surgeons, more than 7 days by 42%, and less than 5 days by 12% surgeons. Most surgeons (77%) restart infants on breast milk, 11.5% on aminoacid-based formulas, and 11.5% on hydrolyzed formulas. Most surgeons (92%) follow-up NEC patients after discharge, up to 5 years of life (56%) and 65% surgeons organize a neurodevelopmental follow-up. CONCLUSIONS: Many aspects of NEC management are lacking consensus and surgeons differ especially over surgical treatment of complex cases and postoperative management. Prospective multi-center studies are needed to guide an evidence-based management of NEC. Georg Thieme Verlag KG Stuttgart · New York.
AIM: The aim of this study is to define patterns in the management of necrotizing enterocolitis (NEC). METHODS: A total of 80 delegates (81% senior surgeons) from 29 (20 European) countries completed a survey at the European Pediatric Surgeons' Association 2013 annual meeting. RESULTS: Overall, 59% surgeons work in centers where>10 cases of NEC are treated per year. DIAGNOSIS: 76% surgeons request both anteroposterior and lateral abdominal X-rays, which are performed at regular intervals by 66%; 50% surgeons also request Doppler ultrasonography; most frequently used biochemical markers are platelets (99% of surgeons), C-reactive protein (90%), and white cell count (83%). Laparoscopy is performed for diagnosis and/or treatment of NEC by only 8% surgeons. Overall, 43% surgeons reported being able to diagnose focal intestinal perforation preoperatively. Medical NEC: medical NEC is managed by surgical and neonatal teams together in most centers (84%). Most surgeons (67%) use a combination of two (51%) or three (48%) antibiotics for more than 7 days, and keep patients nil by mouth for 7 (41%) or 10 (49%) days. Surgical NEC: In extremely low-birth-weight infants (< 1,000 g) with intestinal perforation, 27% surgeons opt for primary peritoneal drainage (PPD) as definitive treatment. Overall, 67% think that peritoneal drainage is important for stabilization and transport. At laparotomy, treatments vary according to NEC severity. About 75% surgeons always close the abdomen, and 29% leave a patch to prevent compartment syndrome. POSTOPERATIVE MANAGEMENT: Infants are kept nil by mouth for 5 to 7 days by 46% surgeons, more than 7 days by 42%, and less than 5 days by 12% surgeons. Most surgeons (77%) restart infants on breast milk, 11.5% on aminoacid-based formulas, and 11.5% on hydrolyzed formulas. Most surgeons (92%) follow-up NEC patients after discharge, up to 5 years of life (56%) and 65% surgeons organize a neurodevelopmental follow-up. CONCLUSIONS: Many aspects of NEC management are lacking consensus and surgeons differ especially over surgical treatment of complex cases and postoperative management. Prospective multi-center studies are needed to guide an evidence-based management of NEC. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Jamie R Robinson; Eric J Rellinger; L Dupree Hatch; Joern-Hendrik Weitkamp; K Elizabeth Speck; Melissa Danko; Martin L Blakely Journal: Semin Perinatol Date: 2016-11-08 Impact factor: 3.300
Authors: Niloofar Ganji; Bo Li; Irfan Ahmad; Alan Daneman; Poorva Deshpande; Vijay Dhar; Simon Eaton; Ricardo Faingold; Estelle B Gauda; Nigel Hall; Salhab El Helou; Mustafa H Kabeer; Jae H Kim; Alice King; Michael H Livingston; Eugene Ng; Martin Offringa; Elena Palleri; Mark Walton; David E Wesson; Tomas Wester; Rene M H Wijnen; Andrew Willan; Rosanna Yankanah; Carlos Zozaya; Prakesh S Shah; Agostino Pierro Journal: Pediatr Surg Int Date: 2022-03-16 Impact factor: 1.827