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Variable management strategies for NEC totalis: a national survey

Abstract

Background/Objectives

Necrotizing enterocolitis (NEC) is a serious disease linked to prematurity. A variant, NEC totalis, is associated with nearly 100% mortality. There is wide variation in counseling practices for NEC totalis. Our objectives are to determine what treatment options, if any, are offered to families, and which factors influence these decisions.

Methods

An anonymous survey was distributed to members of the AAP Sections on Neonatal-Perinatal Medicine and Pediatric Surgery. Data were analyzed utilizing chi-square tests and Spearman correlations, where applicable.

Results

In the setting of NEC totalis, 90% of the 378 respondents viewed offering life-sustaining interventions (LSI) as ethically permissible and 87% felt that transfer to another center willing to provide LSI should be considered; however, only 43% reported offering LSI to families.

Conclusions

Management of NEC totalis remains challenging and significant practice variability persists. Most respondents do not offer ongoing medical/surgical management, despite believing it is an ethically permissible option.

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Correspondence to Alaina K. Pyle.

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Pyle, A.K., Shabanova, V., Cleary, M.A. et al. Variable management strategies for NEC totalis: a national survey. J Perinatol 39, 1521–1527 (2019). https://doi.org/10.1038/s41372-019-0448-0

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