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  • Clinical Research Article
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Outcomes by disease onset, sex, and intervention in neonates with SIP and surgical NEC

Pediatric Research volume 95, pages 1009–1021 (2024)Cite this article

Abstract

Background

Outcomes of infants following surgical necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) categorized by the age of onset, interventions, and sex are not well defined.

Methods

Retrospective comparison of infants categorized by age of onset (NEC at <10, 10–20, and >20 days) and SIP at <7 versus ≥7 days), sex, and intervention [Penrose Drain (PD) vs. laparotomy].

Results

A total of 114 infants had NEC and 37 had SIP. On multinomial logistic regression, infants with NEC/SIP onset >20 days had significantly lower odds of small bowel involvement (aOR = 0.07, 95% CI: 0.01–0.33, p = 0.001), higher necrosis (aOR = 3.59, 95% CI: 1.34–9.65, p = 0.012) and higher CRP (p = 0.004) than onset <10 days. Initial laparotomy was associated with more bowel loss (24.1 cm [12.3; 40.6] vs.12.1 [8.00; 23.2]; p = 0.001), small and large intestine involvement (47.1% vs 17.2%; p = 0.01), and ileocecal valve resection (42% vs. 19.4%; p = 0.036) than initial PD therapy. Females underwent fewer small bowel resections (52.3% vs 73.6%; p = 0.025) but had higher surgical morbidity (53.7% vs. 24.7%.; p = 0.001) than males.

Conclusion

Clinical, radiological, and histopathological presentation and outcomes in preterm infants with surgical NEC/SIP are associated with age of disease onset, sex, and initial intervention.

Impact

  • Neonates with surgical NEC onset >20 days had more severe necrosis, inflammation, kidney injury, and bowel loss than those with <10 days.

  • Initial laparotomy was associated with later age onset, more bowel loss, and ileocecal valve resection compared to initial PD treatment, but not with differences in mortality or length of stay.

  • Female sex was associated with lower maturity, more placental malperfusion, less often small bowel involvement, lower pre-NEC hematocrit as well as higher surgical morbidity than males.

  • Whether the management of surgical NEC and SIP should differ by the age of onset requires further investigation.

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Fig. 1
Fig. 2
Fig. 3: Odds ratio plot showing the association between female sex and relevant predictors.

Data availability

All data generated and analyzed during this study are included in this article and its Supplementary information files.

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Acknowledgements

The Mississippi Center for Clinical and Translational Research for supporting the NEC research. We are grateful to Dr Neu from the University of Florida for all the guidance and feedback.

Funding

P.M.G. and W.H. are partially supported by the NIGMS of the NIH under Award Number U54GM115428. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

  1. Department of Pediatrics/Neonatology, Wake Forest University, Winston-Salem, NC, USA

    Parvesh Mohan Garg & Jeffrey S. Shenberger

  2. Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, MI, USA

    Parvesh Mohan Garg, Katheryn Lett, Helen Cunningham, Jennifer Ware, Isabella Pittman & Robin Riddick

  3. Department of Data Sciences, University of Mississippi Medical Center, Jackson, MI, USA

    Md Abu Yusuf Ansari & William Hillegass

  4. Department of Pediatric Surgery, University of Mississippi Medical Center, Jackson, MI, USA

    David Sawaya & Berry Berch

  5. Department of Pathology, University of Mississippi Medical Center, Jackson, MI, USA

    Michael Morris & Neha Varshney

  6. Department of Radiology, University of Mississippi Medical Center, Jackson, MI, USA

    Charlotte Taylor & Kartik Reddy

  7. Department of Medicine, University of Mississippi Medical Center, Jackson, MI, USA

    William Hillegass

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  1. Parvesh Mohan Garg
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Contributions

P.M.G. designed the study. P.M.G., K.L., M.A.Y.A., H.C., J.W., I.P., R.R., N.V., C.T., K.R., M.M., B.B., D.S., J.S.S., and W.H. collected and analyzed the data. P.M.G. wrote the article. All the authors approved the manuscript.

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Correspondence to Parvesh Mohan Garg.

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Garg, P.M., Lett, K., Ansari, M.A.Y. et al. Outcomes by disease onset, sex, and intervention in neonates with SIP and surgical NEC. Pediatr Res 95, 1009–1021 (2024). https://doi.org/10.1038/s41390-023-02749-1

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