Outcome of very premature infants with necrotising enterocolitis cared for in centres with or without on site surgical facilities
M Loha, D A Osbornb, K Luic, on behalf of the NSW Neonatal Intensive Care Unit Study (NICUS) group
a Royal Hospital for
Women, Randwick, NSW, Australia, b Royal Prince Alfred Hospital, Camperdown, NSW,
Australia, c School of
Paediatrics, University of New South Wales, Sydney, NSW, Australia
Correspondence to: Dr Lui, Department of Newborn Care, Royal Hospital for Women, Barker Street, Randwick, New South Wales, Australia 2031 k.lui{at}unsw.edu.au
Accepted 3 April 2001
OBJECTIVE
To determine
if the presence of a neonatal surgical facility on site has any effect
on mortality and morbidity of very premature infants with necrotising
enterocolitis (NEC).
DESIGN AND
SETTINGRetrospective review of infants of less
than 29 weeks gestation cared for in the seven perinatal centres in New
South Wales.
PATIENTSBetween
1992 and 1997, 605 infants were cared for in two centres with in house
surgical facilities (group 1) and 1195 in five centres where transfers
were required for surgical management (group 2).
RESULTSAlthough use
of antenatal steroids was significantly lower in group 1 centres than
group 2 centres (74% v 85% respectively), and the incidence of hyaline membrane disease, pneumothorax, and NEC
was higher, mortality was identical (27%). Fifty two (9%) infants in
group 1 and 72 (6%) in group 2 of comparable perinatal characteristics
and CRIB (Clinical Risk Index for Babies) scores developed
radiologically or pathologically proven NEC. The overall mortality of
infants with NEC in group 1 was lower but this was not statistically
significant (27% v 35%). Significantly
more infants with NEC in group 1 had surgery (69%
v 39%). There were fewer postoperative
deaths in group 1 and more deaths without surgery in group 2. The
duration of respiratory and nutritional support and hospital stay for
the survivors were similar in the two groups. In a multivariate
analysis, shorter gestation was the only factor associated with
mortality in infants with NEC; the presence of in house surgical
facilities was not.
CONCLUSIONSThere were
no significant differences in outcome of premature infants with NEC
managed in perinatal centres with or without on site surgical
facilities. Early transfers should be encouraged. This finding may have
implications for future planning of facilities for neonatal care.
Keywords: necrotising enterocolitis; premature infants; transfer; mortality
© 2001 by Archives of Disease in Childhood
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