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Long-term outcome of surgically managed necrotizing enterocolitis in a developing country

dc.contributor.authorArnold M.
dc.contributor.authorMoore S.W.
dc.contributor.authorSidler D.
dc.contributor.authorKirsten G.F.
dc.date.accessioned2011-05-15T16:03:45Z
dc.date.available2011-05-15T16:03:45Z
dc.date.issued2010
dc.identifier.citationPediatric Surgery International
dc.identifier.citation26
dc.identifier.citation4
dc.identifier.issn1790358
dc.identifier.other10.1007/s00383-010-2583-8
dc.identifier.urihttp://hdl.handle.net/10019.1/12764
dc.description.abstractNecrotizing enterocolitis (NEC) is a serious condition with a high morbidity and mortality commonly affecting premature babies. Data for the impact of the longterm disease burden in developing countries are limited although poor long-term outcome of surgically managed patients has been shown in terms of increased risk of neurodevelopmental delay, increased infectious disease burden and abnormal neurological outcomes in the developed world. Purpose To evaluate the long-term outcome of a prehuman immunodeficiency virus pandemic NEC cohort to characterize common risk factors and outcome in a developing world setting. Methods A retrospective review of medical records was carried out on a cohort of 128 premature neonates with surgical NEC (1992-1995). Morbidity, mortality and longterm outcome were evaluated. Results: Data for 119 of 128 sequentially managed neonates with surgically treated NEC was available. Mean gestational age was 32 weeks and average birth weight was 1,413 g. Early (30-day postoperative) survival was 69% (n = 82) overall and 71% in the <1,500 g birth weight group (n = 68; 53%). Overwhelming sepsis (n = 16) or pan-intestinal necrosis (n = 18) accounted for most of the early deaths. Late deaths (>30 days postoperatively n = 22) resulted from short bowel syndrome (5), sepsis (9), intraventricular hemorrhage (1) and undetermined causes (7). On follow-up (mean follow-up 39 months, 30 for>2 years), long-term mortality increased to 50%. Late surgical complications included late colonic strictures (9), incisional hernias (2) and adhesive bowel obstruction (3). Fifteen patients had short bowel syndrome, of which 10 (66%) survived. Of the long-term survivors, 8 (20%) had severe neurological deficits and 20 (49%) had significant neurodevelopmental delay. Neurological deficits included severe auditory impairment [5 (12%)] and visual impairment [4 (10%)]. Recurrent infections and gastrointestinal tract complaints requiring hospital admission occurred in 16 (39%) of survivors. Conclusion Necrotizing enterocolitis in premature infants impacts morbidity and mortality considerably. A number do well in a developing country, but septic complications may be ongoing and recurrent. The high risk of neurodevelopmental and other problems continue beyond the neonatal period and patients should be "flagged" on for careful follow-up. © Springer-Verlag 2010.
dc.subjectarticle
dc.subjectbirth weight
dc.subjectbrain hemorrhage
dc.subjectcohort analysis
dc.subjectdeveloping country
dc.subjectfollow up
dc.subjectgastrointestinal symptom
dc.subjectgastrointestinal tract
dc.subjectgestational age
dc.subjecthospital admission
dc.subjecthuman
dc.subjectincisional hernia
dc.subjectintestine necrosis
dc.subjectintestine obstruction
dc.subjectmajor clinical study
dc.subjectmedical record review
dc.subjectmorbidity
dc.subjectmortality
dc.subjectnecrotizing enterocolitis
dc.subjectnewborn
dc.subjectnewborn period
dc.subjectpandemic
dc.subjectpostoperative complication
dc.subjectprematurity
dc.subjectpriority journal
dc.subjectrecurrent infection
dc.subjectretrospective study
dc.subjectrisk factor
dc.subjectsepsis
dc.subjectshort bowel syndrome
dc.subjecttreatment outcome
dc.subjectvisual impairment
dc.subjectcost of illness
dc.subjectfemale
dc.subjectinfant
dc.subjectintestine
dc.subjectmale
dc.subjectnecrosis
dc.subjectpathology
dc.subjectpreschool child
dc.subjectSouth Africa
dc.subjectstatistics
dc.subjectsurvival
dc.subjectChild, Preschool
dc.subjectCohort Studies
dc.subjectCost of Illness
dc.subjectDeveloping Countries
dc.subjectEnterocolitis, Necrotizing
dc.subjectFemale
dc.subjectFollow-Up Studies
dc.subjectHumans
dc.subjectInfant
dc.subjectInfant, Newborn
dc.subjectIntestines
dc.subjectMale
dc.subjectNecrosis
dc.subjectPostoperative Complications
dc.subjectRetrospective Studies
dc.subjectRisk Factors
dc.subjectSepsis
dc.subjectShort Bowel Syndrome
dc.subjectSouth Africa
dc.subjectSurvival Analysis
dc.subjectTreatment Outcome
dc.titleLong-term outcome of surgically managed necrotizing enterocolitis in a developing country
dc.typeArticle
dc.description.versionArticle


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