Outcome of infants with necrotising enterocolitis at Charlotte Maxeke Johannesburg Academic Hospital, South Africa
Article Sidebar
Main Article Content
Abstract
Background. Necrotising enterocolitis (NEC) is an inflammatory disease almost exclusively affecting preterm infants. Previous research has presented a higher mortality rate in infants requiring surgical treatment compared with infants receiving medical treatment. However, the knowledge of mortality and morbidity of the disease in low- and middle-income countries is still limited.
Objectives. To review infants with NEC admitted to the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH),
determine a potential difference in mortality between medically and surgically treated infants, and to identify characteristics and factors associated with mortality among these infants.
Methods. This retrospective study described infants with NEC born between 1 January 2016 and 31 December 2018 who were admitted
to the neonatal unit. The characteristics and survival of these infants were compared using univariate and multivariate analyses.
Results. During the study period, 5 061 infants were admitted to the neonatal unit, of which 218 infants were diagnosed with NEC.
The period prevalence of NEC was 4.3% among all neonatal infants and 11.0% among very-low-birthweight (VLBW) infants. Mortality
was significantly higher among surgically treated infants with NEC compared with medically treated infants (p=0.025, odds ratio 1.888
(95% confidence interval 1.082 - 3.296)). Late-onset sepsis was significantly more common among VLBW infants with NEC (71.3%)
compared with VLBW infants without NEC (27.1%). Among infants with late-onset sepsis, Gram-negative bacteria, multidrug-resistant
bacteria and fungal sepsis was significantly more common in the group of infants with NEC.
Conclusions. Infants with NEC treated surgically at CMJAH have an increased risk of dying compared with those receiving medical
treatment, likely due to the severity of disease. Furthermore, this study emphasised the burden of sepsis among infants with NEC and may contribute to a better knowledge of NEC in South Africa.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJCH is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of under-5 mortality in 2000 - 15: An updated systematic analysis with implications for the Sustainable Development Goals. Lancet 2016;388(10063):3027-3035 https:// doi.org/10.1016/S0140-6736(16)31593-8
Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med 2011;364(3):255- 264. https://doi.org/10.1056/NEJMra1005408
Yee WH, Soraisham AS, Shah VS, Aziz K, Yoon W, Lee SK. Incidence and timing of presentation of necrotizing enterocolitis in preterm infants. Pediatrics 2012;129(2):e298-304. https://doi.org/10.1542/peds.2011-2022
Walsh MC, Kliegman RM. Necrotizing enterocolitis: Treatment based on staging criteria. Pediatr Clin North Am 1986;33(1):179-201. https://doi. org/10.1016/s0031-3955(16)34975-6
Frost BL, Modi BP, Jaksic T, Caplan MS. New medical and surgical insights into neonatal necrotizing enterocolitis: A review. JAMA Pediatr 2017;171(1):83-88. https://doi.org/10.1001/jamapediatrics.2016.2708
Thakkar HS, Lakhoo K. The surgical management of necrotising enterocolitis (NEC). Early Hum Dev 2016;97:25-28. https://doi.org/10.1016/j. earlhumdev.2016.03.002
Battersby C, Santhalingam T, Costeloe K, Modi N. Incidence of neonatal necrotising enterocolitis in high-income countries: A systematic review. Arch Dis Child Fetal Neonatal Ed 2018;103(2):F182-F189. https://doi.org/10.1136/ archdischild-2017-313880
Hull MA, Fisher JG, Gutierrez IM, et al. Mortality and management of surgical necrotizing enterocolitis in very low birth weight neonates: A prospective cohort study. J Am Coll Surg 2014;218(6):1148-1155. https://doi.org/10.1016/j. jamcollsurg.2013.11.015
Jones IH, Hall NJ. Contemporary outcomes for infants with necrotizing enterocolitis – a systematic review. J Pediatr 2020;220:86-92. https://doi. org/10.1016/j.jpeds.2019.11.011
Satardien M, Van Wyk L, Sidler D, Van Zyl JI. Outcomes of neonates requiring neonatal intensive care admission for necrotizing enterocolitis in a resource- restricted hospital in Cape Town, South Africa. J Trop Pediatr 2021;67(1):1-10. https://doi.org/10.1093/tropej/fmaa130
Ballot DE, Davies VA, Cooper PA, Chirwa T, Argent A, Mer M. Retrospective cross-sectional review of survival rates in critically ill children admitted to a combined paediatric/neonatal intensive care unit in Johannesburg, South Africa, 2013 - 2015. BMJ Open 2016;6(6):e010850. https://doi.org/10.1136/ bmjopen-2015-010850
Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet 2017;390(10104):1770- 1780. https://doi.org/10.1016/s0140-6736(17)31002-4
Guthrie SO, Gordon PV, Thomas V, Thorp JA, Peabody J, Clark RH. Necrotizing enterocolitis among neonates in the United States. J Perinatol 2003;23(4):278- 285. https://doi.org/10.1038/sj.jp.7210892
World Health Organization. Neonatal Mortality Rate, Year: 2018. Geneva: WHO, 2018. http://apps.who.int/gho/data/node.sdg.3-2-viz-3?lang=en (accessed 27 March 2020).
Platt MJ. Outcomes in preterm infants. Public Health 2014;128(5):399-403.
https://doi.org/10.1016/j.puhe.2014.03.010
inghM,OwenA,GullS,MorabitoA,BianchiA.Surgeryforintestinalperforation Sin preterm neonates: Anastomosis vs stoma. J Pediatr Surg 2006;41(4):725-729. https://doi.org/10.1016/j.jpedsurg.2005.12.017
Banieghbal B, Davies MR. Damage control laparotomy for generalised necrotizing enterocolitis. World J Surg 2004;28(2):183-186. https://doi.org/10.1007/s00268- 003-7155-9
Bizzarro MJ, Ehrenkranz RA, Gallagher PG. Concurrent bloodstream infections in infants with necrotizing enterocolitis. J Pediatr 2014;164(1):61- 66. https://doi.org/10.1016/j.jpeds.2013.09.020
Elfvin A, Dinsdale E, Wales PW, Moore AM. Low birthweight, gestational age, need for surgical intervention and Gram-negative bacteraemia predict intestinal failure following necrotising enterocolitis. Acta Paediatr 2015;104(8):771-776. https://doi.org/10.1111/apa.12997
Röjås S, Borg H, Edenholm M, Sandberg K, Elfvin A. Abdominal pathology requiring laparotomy in very preterm infants is associated with need for surgical closure of patent ductus arteriosus. J Pediatr Surg 2011;46(10):1898- 1902. https://doi.org/10.1016/j.jpedsurg.2011.06.028
Rose AT, Patel RM. A critical analysis of risk factors for necrotizing enterocolitis. Semin Fetal Neonatal Med 2018;23(6):374-379. https://doi.org/10.1016/j. siny.2018.07.005
Hay S, Zupancic JA, Flannery DD, Kirpalani H, Dukhovny D. Should we believe in transfusion-associated enterocolitis? Applying a GRADE to the literature. Semin Perinatol 2017;41(1):80-91. https://doi.org/10.1053/j. semperi.2016.09.021
Fitzgibbons SC, Ching Y, Yu D, et al. Mortality of necrotizing enterocolitis expressed by birth weight categories. J Pediatr Surg 2009;44(6):1072-1075. https://doi.org/10.1016/j.jpedsurg.2009.02.013