Brian P Blackwood1,2, Catherine J Hunter1, Julia Grabowski1. 1. 1 Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois. 2. 2 Department of General Surgery, Rush University Medical Center , Chicago, Illinois.
Abstract
BACKGROUND: Necrotizing enterocolitis or NEC is the most common gastrointestinal emergency in the newborn. The etiology of NEC remains unknown, and treatment consists of antibiotic therapy and supportive care with the addition of surgical intervention as necessary. Unlike most surgical diseases, clear guidelines for the type and duration of peri-operative antibiotic therapy have not been established. Our aim was to review the antibiotic regimen(s) applied to surgical patients with NEC within a single neonatal intensive care unit (NICU) and to evaluate outcomes and help develop guidelines for antibiotic administration in this patient population. PATIENTS AND METHODS: A single-center retrospective review was performed of all patients who underwent surgical intervention for NEC from August 1, 2005 through August 1, 2015. Relevant data were extracted including gestational age, age at diagnosis, gender, pre-operative antibiotic treatment, post-operative antibiotic treatment, development of stricture, and mortality. Patients were excluded if there was incomplete data documentation. RESULTS: A total of 90 patients were identified who met inclusion criteria. There were 56 male patients and 34 female patients. The average gestational age was 30 5/7 wks and average age of diagnosis 16.7 d. A total of 22 different pre-operative antibiotic regimens were identified with an average duration of 10.6 d. The most common pre-operative regimen was ampicillin, gentamicin, and metronidazole for 14 d. A total of 15 different post-operative antibiotic regimens were identified with an average duration of 6.6 d. The most common post-operative regimen was ampicillin, gentamicin, and metronidazole for two days. There were 26 strictures and 15 deaths. No regimen or duration proved superior. CONCLUSION: We found that there is a high degree of variability in the antibiotic regimen for the treatment of NEC, even within a single NICU, with no regimen appearing superior over another. As data emerge that demonstrate the adverse effects of antibiotic overuse, our findings highlight the need for guidelines in the antibiotic treatment of NEC and suggest that an abbreviated course of post-operative antibiotics may be safe.
BACKGROUND:Necrotizing enterocolitis or NEC is the most common gastrointestinal emergency in the newborn. The etiology of NEC remains unknown, and treatment consists of antibiotic therapy and supportive care with the addition of surgical intervention as necessary. Unlike most surgical diseases, clear guidelines for the type and duration of peri-operative antibiotic therapy have not been established. Our aim was to review the antibiotic regimen(s) applied to surgical patients with NEC within a single neonatal intensive care unit (NICU) and to evaluate outcomes and help develop guidelines for antibiotic administration in this patient population. PATIENTS AND METHODS: A single-center retrospective review was performed of all patients who underwent surgical intervention for NEC from August 1, 2005 through August 1, 2015. Relevant data were extracted including gestational age, age at diagnosis, gender, pre-operative antibiotic treatment, post-operative antibiotic treatment, development of stricture, and mortality. Patients were excluded if there was incomplete data documentation. RESULTS: A total of 90 patients were identified who met inclusion criteria. There were 56 male patients and 34 female patients. The average gestational age was 30 5/7 wks and average age of diagnosis 16.7 d. A total of 22 different pre-operative antibiotic regimens were identified with an average duration of 10.6 d. The most common pre-operative regimen was ampicillin, gentamicin, and metronidazole for 14 d. A total of 15 different post-operative antibiotic regimens were identified with an average duration of 6.6 d. The most common post-operative regimen was ampicillin, gentamicin, and metronidazole for two days. There were 26 strictures and 15 deaths. No regimen or duration proved superior. CONCLUSION: We found that there is a high degree of variability in the antibiotic regimen for the treatment of NEC, even within a single NICU, with no regimen appearing superior over another. As data emerge that demonstrate the adverse effects of antibiotic overuse, our findings highlight the need for guidelines in the antibiotic treatment of NEC and suggest that an abbreviated course of post-operative antibiotics may be safe.
Authors: Augusto Zani; Simon Eaton; Prem Puri; Risto Rintala; Marija Lukac; Pietro Bagolan; Joachim F Kuebler; Michael E Hoellwarth; Rene Wijnen; Juan Tovar; Agostino Pierro Journal: Eur J Pediatr Surg Date: 2014-10-26 Impact factor: 2.191
Authors: Cynthia D Downard; Elizabeth Renaud; Shawn D St Peter; Fizan Abdullah; Saleem Islam; Jacqueline M Saito; Martin L Blakely; Eunice Y Huang; Marjorie J Arca; Laura Cassidy; Gudrun Aspelund Journal: J Pediatr Surg Date: 2012-11 Impact factor: 2.545
Authors: Martin L Blakely; Kevin P Lally; Scott McDonald; Rebeccah L Brown; Douglas C Barnhart; Richard R Ricketts; W Raleigh Thompson; L R Scherer; Michael D Klein; Robert W Letton; Walter J Chwals; Robert J Touloukian; Arlett G Kurkchubasche; Michael A Skinner; R Lawrence Moss; Mary L Hilfiker Journal: Ann Surg Date: 2005-06 Impact factor: 12.969
Authors: Rebecca R Roberts; Bala Hota; Ibrar Ahmad; R Douglas Scott; Susan D Foster; Fauzia Abbasi; Shari Schabowski; Linda M Kampe; Ginevra G Ciavarella; Mark Supino; Jeremy Naples; Ralph Cordell; Stuart B Levy; Robert A Weinstein Journal: Clin Infect Dis Date: 2009-10-15 Impact factor: 9.079
Authors: Shelley S Magill; Jonathan R Edwards; Wendy Bamberg; Zintars G Beldavs; Ghinwa Dumyati; Marion A Kainer; Ruth Lynfield; Meghan Maloney; Laura McAllister-Hollod; Joelle Nadle; Susan M Ray; Deborah L Thompson; Lucy E Wilson; Scott K Fridkin Journal: N Engl J Med Date: 2014-03-27 Impact factor: 91.245
Authors: Leena B Mithal; Ram Yogev; Hannah L Palac; Daniel Kaminsky; Ilan Gur; Karen K Mestan Journal: Early Hum Dev Date: 2018-01-23 Impact factor: 2.079
Authors: Katelyn E Bull; Andrew B Gainey; Christina L Cox; Anna-Kathryn Burch; Martin Durkin; Robert Daniels Journal: J Pediatr Pharmacol Ther Date: 2021-02-15
Authors: Rina A Ferguson; Joshua C Herigon; Brian R Lee; Mari M Nakamura; Jason G Newland Journal: J Pediatric Infect Dis Soc Date: 2021-05-28 Impact factor: 3.164
Authors: Joseph Y Ting; Julie Autmizguine; Michael S Dunn; Julie Choudhury; Julie Blackburn; Shikha Gupta-Bhatnagar; Katrin Assen; Julie Emberley; Sarah Khan; Jessica Leung; Grace J Lin; Destiny Lu-Cleary; Frances Morin; Lindsay L Richter; Isabelle Viel-Thériault; Ashley Roberts; Kyong-Soon Lee; Erik D Skarsgard; Joan Robinson; Prakesh S Shah Journal: Front Pediatr Date: 2022-07-08 Impact factor: 3.569