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One-year outcomes following surgery for necrotising enterocolitis: a UK-wide cohort study
  1. Benjamin Saul Raywood Allin1,2,
  2. Anna-May Long1,2,
  3. Amit Gupta3,
  4. Kokila Lakhoo2,
  5. Marian Knight1
  6. The British Association of Paediatric Surgeons Congenital Anomalies Surveillance System Necrotising Enterocolitis Collaboration
  1. 1 National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
  2. 2 Department of Paediatric Surgery, Oxford Children’s Hospital, Oxford, UK
  3. 3 Neonatal Intensive Care Unit, Oxford Children’s Hospital, Oxford, UK
  1. Correspondence to Dr Benjamin Saul Raywood Allin, National Perinatal Epidemiology Unit, University of Oxford, Headington, Oxford, OX3 7LF, UK; benjaminallin{at}doctors.org.uk

Abstract

Objective The objective was to describe outcomes and investigate factors affecting prognosis at 1 year post intervention for infants with surgical necrotising enterocolitis (NEC).

Design Using the British Association of Paediatric Surgeons Congenital Anomalies Surveillance System, we conducted a prospective, multicentre cohort study of every infant reported to require surgical intervention for NEC in the UK and Ireland between 1 March 2013 and 28 February 2014. Association of independent variables with 1-year mortality was investigated using multivariable logistic regression analysis.

Setting All 28 paediatric surgical centres in the UK and Ireland.

Patients Infants were eligible for inclusion if they were diagnosed with NEC and deemed to require surgical intervention, regardless of whether that intervention was delivered.

Outcomes Primary outcome was mortality within 1 year of the decision to intervene surgically.

Results 236 infants were included in the study. 208 (88%) infants had 1-year follow-up. 59 of the 203 infants with known survival status (29%, 95% CI 23% to 36%) died within 1 year of the decision to intervene surgically. Following adjustment, key factors associated with reduced 1-year mortality included older gestational age at birth (adjusted OR (aOR) 0.87, 95% CI 0.78 to 0.96). Being small for gestational age (SGA) (aOR 3.6, 95% CI 1.4 to 9.5) and requiring parenteral nutrition at 28 days post-decision to intervene surgically (aOR 3.5, 95% CI 1.1 to 11.03) were associated with increased 1-year mortality.

Conclusions Parents of infants undergoing surgery for NEC should be counselled that there is approximately a 1:3 risk of death in the first post-operative year but that the risk is lower for infants who are of greater gestational age at birth, who are not SGA and who do not require parenteral nutrition at 28 days post-intervention.

  • necrotising enterocolitis
  • paediatric surgery
  • gastroenterology
  • neonatology

This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • KL and MK contributed equally.

  • Contributors BSRA was responsible for developing the analysis strategy, conducting data analysis and manuscript drafting and revision. A-ML, AG, MK and KL were responsible for design of the study along with critical revision of the manuscript. The BAPS–CASS collaboration as described above was responsible for data collection.

  • Funding Marian Knight is funded by a National Institute for Health Research (NIHR) Professorship. Benjamin Allin is funded by a National Institute for Health Research (NIHR) Doctoral Research Fellowship. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The NIHR had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication BA and MK had full access to the to all of the data in the study, and can take responsibility for the integrity of the data, and accuracy of the data analysis. MK, as lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Competing interests None declared.

  • Ethics approval Ethical approval for the study was granted by the National Research Ethics Service Committee South Central – Oxford A (Study reference number 12/SC/0416).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Collaborators Marcin Kazmierski (Addenbrooke’s Hospital), Simon Kenny (Alder Hey Children’s Hospital), Joana Lopes (Birmingham Children’s Hospital), Eleri Cusick (Bristol Royal Hospital for Children), Gilian Parsons (Chelsea and Westminster Hospital), Amanda McCabe (Edinburgh Royal Hospital for Sick Children), Manasvi Upadhyaya (Evelina Children’s Hospital), Gregor Walker (Glasgow Royal Hospital for Sick Children), Paulo De Coppi (Great Ormond Street Hospital for Sick Children), Sania Besarovic (Hull Royal Infirmary), Hemanshoo Thakkar (Oxford Children’s Hospital), Lucinda Tullie (King’s College Hospital), Jonathan Sutcliffe (Leeds General Infirmary), Bala Eradi (Leicester Royal Infirmary), Andrew Ross (Norfolk and Norwich University), Nomsa Maphango (Our Lady’s Hospital for Sick Children), Sandeep Motiwale (Queen’s Medical Centre), Adnan Salloum (Royal Aberdeen Children’s Hospital), Caroline Pardy (Royal Alexandra Children’s Hospital), Ramy Waly (Belfast Hospital for Sick Children), Paul Charlesworth (Royal London Hospital), Ross Craigie (Royal Manchester Children’s Hospital), Anupam Lall (Royal Victoria Infirmary), Richard Lindley (Sheffield Children’s Hospital), Navroop Johal (Southampton General), Ike Njere (St George’s Hospital), Alan Mortell (The Children’s University Hospital), Bip Nandi (University Hospital of Wales), Abigail Jones (Sheffield Children’s Hospital), Dina Fouad (Norfolk and Norwich University Hospital), Yew-Wei Tan (King’s College Hospital), Dorothy Kufeji (Evelina Children’s Hospital), Joanna Stanwell (Great Ormond Street Hospital for Sick Children), Bhanu Lakshminarayanan (King’s College Hospital), David Burge (Southampton General), Charlotte Wetherill (Leeds General Infirmary), Anindya Niyogi (Royal Victoria Infirmary), Chris Parsons (Great Ormond Street Hospital for Sick Children), Miriam Doyle (The Children’s University Hospital), Alex Turner (Alder Hey Children’s Hospital), Ian Yardley (Evelina Children’s Hospital), Ram Shrestha (University Hospital of Wales), Dhanya Mullassery (Alder Hey Children’s Hospital), Saravankumar Paramalingham (Royal Alexandra Children’s Hospital) and Simone Ragazzi (Royal London Hospital).

  • Presented at A subset of the results upon which this manuscript is based were presented at the annual congress of the British Association of Paediatric Surgeons.

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