Do more mature preterm babies with surgical necrotizing enterocolitis predominantly develop the colonic disease?

Background The primary aim was to scrutinize our hypothesis: “Do more mature preterm (MMP) babies with surgical necrotizing enterocolitis (NEC) predominantly develop the colonic disease and are different in their response and behaviour in comparison to exceedingly preterm (EP) babies?” Secondary out...

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Main Authors: Sarah Martin, Chandrasen K Sinha, Iona Ashworth, Sadaf Bhayat, Anay Kulkarni
Format: Article
Language:English
Published: BMJ Publishing Group 2021-04-01
Series:World Journal of Pediatric Surgery
Online Access:https://wjps.bmj.com/content/4/1/e000246.full
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spelling doaj-be95fc88e67f4864a7cd5fea78cbd9d22021-04-05T09:00:11ZengBMJ Publishing GroupWorld Journal of Pediatric Surgery2516-54102021-04-014110.1136/wjps-2020-000246Do more mature preterm babies with surgical necrotizing enterocolitis predominantly develop the colonic disease?Sarah Martin0Chandrasen K Sinha1Iona Ashworth2Sadaf Bhayat3Anay Kulkarni4Neonatology, St George's University Hospitals NHS Foundation Trust, London, London, UKPaediatric Surgery, St George's University Hospitals NHS Foundation Trust, London, UKNeonatology, St George's University Hospitals NHS Foundation Trust, London, London, UKNeonatology, St George's University Hospitals NHS Foundation Trust, London, London, UKNeonatology, St George's University Hospitals NHS Foundation Trust, London, London, UKBackground The primary aim was to scrutinize our hypothesis: “Do more mature preterm (MMP) babies with surgical necrotizing enterocolitis (NEC) predominantly develop the colonic disease and are different in their response and behaviour in comparison to exceedingly preterm (EP) babies?” Secondary outcomes were to define time taken in developing NEC, time from diagnosis to laparotomy, requirement of parenteral nutrition (PN), and ventilatory support.Methods We defined MMP babies as ≥30 weeks of gestation and EP babies as ≤29 weeks+6 days of gestation. Inclusion criteria were all babies <37 weeks with NEC requiring surgery (called surgical NEC group). Data were collected retrospectively and analyzed using QuickCalcs.Results Of the total, 41% (97/234) of babies underwent laparotomy between 2010 and 2019. Totally, 81% were EP and 19% were MMP babies. Pure colonic involvement was seen in 9% of EP babies in comparison to 56% in the MMP babies (p=0.0001). Involvement of only the small bowel was seen in two-thirds of EP babies in comparison to only one-third in MMP babies (p=0.01). EP cohort required PN for 82 days (median) in comparison to 17 days (median) in the MMP cohort (p=0.001). Ventilation requirement in the EP group versus the MMP group was 24 vs 9 days (median), respectively (p=0.0006).Conclusions MMP babies predominantly developed colonic disease, whereas EP babies predominantly developed small bowel disease. EP babies required a longer duration of PN and ventilation support. This study opens a new area of research to differentiate pathogenesis and maturation patterns of the small and large bowels in babies with NEC.https://wjps.bmj.com/content/4/1/e000246.full
collection DOAJ
language English
format Article
sources DOAJ
author Sarah Martin
Chandrasen K Sinha
Iona Ashworth
Sadaf Bhayat
Anay Kulkarni
spellingShingle Sarah Martin
Chandrasen K Sinha
Iona Ashworth
Sadaf Bhayat
Anay Kulkarni
Do more mature preterm babies with surgical necrotizing enterocolitis predominantly develop the colonic disease?
World Journal of Pediatric Surgery
author_facet Sarah Martin
Chandrasen K Sinha
Iona Ashworth
Sadaf Bhayat
Anay Kulkarni
author_sort Sarah Martin
title Do more mature preterm babies with surgical necrotizing enterocolitis predominantly develop the colonic disease?
title_short Do more mature preterm babies with surgical necrotizing enterocolitis predominantly develop the colonic disease?
title_full Do more mature preterm babies with surgical necrotizing enterocolitis predominantly develop the colonic disease?
title_fullStr Do more mature preterm babies with surgical necrotizing enterocolitis predominantly develop the colonic disease?
title_full_unstemmed Do more mature preterm babies with surgical necrotizing enterocolitis predominantly develop the colonic disease?
title_sort do more mature preterm babies with surgical necrotizing enterocolitis predominantly develop the colonic disease?
publisher BMJ Publishing Group
series World Journal of Pediatric Surgery
issn 2516-5410
publishDate 2021-04-01
description Background The primary aim was to scrutinize our hypothesis: “Do more mature preterm (MMP) babies with surgical necrotizing enterocolitis (NEC) predominantly develop the colonic disease and are different in their response and behaviour in comparison to exceedingly preterm (EP) babies?” Secondary outcomes were to define time taken in developing NEC, time from diagnosis to laparotomy, requirement of parenteral nutrition (PN), and ventilatory support.Methods We defined MMP babies as ≥30 weeks of gestation and EP babies as ≤29 weeks+6 days of gestation. Inclusion criteria were all babies <37 weeks with NEC requiring surgery (called surgical NEC group). Data were collected retrospectively and analyzed using QuickCalcs.Results Of the total, 41% (97/234) of babies underwent laparotomy between 2010 and 2019. Totally, 81% were EP and 19% were MMP babies. Pure colonic involvement was seen in 9% of EP babies in comparison to 56% in the MMP babies (p=0.0001). Involvement of only the small bowel was seen in two-thirds of EP babies in comparison to only one-third in MMP babies (p=0.01). EP cohort required PN for 82 days (median) in comparison to 17 days (median) in the MMP cohort (p=0.001). Ventilation requirement in the EP group versus the MMP group was 24 vs 9 days (median), respectively (p=0.0006).Conclusions MMP babies predominantly developed colonic disease, whereas EP babies predominantly developed small bowel disease. EP babies required a longer duration of PN and ventilation support. This study opens a new area of research to differentiate pathogenesis and maturation patterns of the small and large bowels in babies with NEC.
url https://wjps.bmj.com/content/4/1/e000246.full
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