Fulminanting necrotising enterocolitis: outcome and prognostic factors.

In order to determine the outcome of infants with fulminant necrotising entercolitis (NEC), the records of 128 surgically-treated neonates were reviewed. Fifty-two were found to have severe, rapid-onset disease. The 30-day survival was determined and correlated with birth weight, gestational age, laboratory and radiological findings, and extent of disease. Seven patients did not respond to resuscitative measures and were treated by percutaneous drainage with a uniformly fatal outcome. For patients who could be made fit for surgery, the only absolute predictor of survival was extent of disease. Pan-necrosis occurred in 19 patients and all of these died. Conversely, patients who had resectable disease had a 30-day survival of 61%. Pan-necrosis could not be determined preoperatively by radiological findings. Patients with severe, rapid-onset NEC and evidence of gangrene who respond to resuscitation should have active surgical management, as approximately one-half of them have resectable disease and a reasonable short-term outcome may be expected. Patients who do not respond to resuscitative measures and those with a surgical finding of pan-necrosis had a uniformly fatal outcome in this study, and if resources are limited, it is reasonable to withdraw active management in this group of patients.