Our Summary

This study is about a severe disease in infants called necrotizing enterocolitis (NEC), in which parts of the bowel tissue die off. Often, when the illness is advanced, surgery is needed to remove the dead areas of the bowel. The researchers had a theory that if any dead tissue is left behind after surgery, the outcomes for the baby would be worse.

To test this, they looked at the medical records of infants who had surgery for NEC over the past 15 years. They collected data about the babies and the disease, and also used statistical models to predict how likely the babies were to die and how long their hospital stays were.

The results showed that, on average, the babies were born at around 27 weeks gestation, weighed around 1008 grams, and the NEC started at around 25 days old. They also found that about 19% of the babies who had all the dead bowel tissue removed had fewer deaths and shorter hospital stays. However, those who had some dead tissue left behind had more deaths and longer hospital stays.

The researchers concluded that leaving dead tissue behind after surgery for NEC can increase the risk of death and lengthen the hospital stay. They also found that using both clinical and histopathological (examining the diseased tissue under a microscope) data gave more accurate predictions of death and length of hospital stay.

The impact of this study is that it shows the importance of removing all dead tissue during surgery for NEC. It also shows that combining different types of data can provide better predictions of outcomes. Other factors that improved the prediction of death included the use of antenatal steroids, inflammation and bleeding in the bowel. Babies born at later gestational ages had shorter hospital stays, but those with deeper necrosis or needing longer nutrition support or feeding supervision had longer hospital stays.

FAQs

  1. Does incomplete resection of necrotic bowel in infants with necrotizing enterocolitis result in inferior clinical outcomes?
  2. How does complete resection of necrotic bowel impact the mortality rate and hospital stay duration in infants with necrotizing enterocolitis?
  3. How does the combination of clinical and histopathological data improve predictions regarding mortality and hospital stay length?

Doctor’s Tip

A helpful tip a doctor might tell a patient about bowel resection is to ensure that the resection is complete, as incomplete resection of necrotic bowel can lead to increased mortality and longer hospital stays. It is important to follow post-operative care instructions carefully and attend follow-up appointments to monitor recovery progress. Additionally, maintaining a healthy diet and staying hydrated can aid in the healing process.

Suitable For

Patients who are typically recommended bowel resection include infants with advanced necrotizing enterocolitis (NEC) who have necrotic patches in their bowel. Incomplete resection of NEC lesions can result in inferior clinical outcomes, including increased mortality and longer hospital stays. It is important for surgeons to ensure complete resection of necrotic bowel in order to improve outcomes for these patients. Additionally, regression models that combine clinical and histopathological data can help predict mortality and hospital stay more accurately in these patients.

Timeline

Before bowel resection:

  • Infant develops necrotizing enterocolitis (NEC)
  • Symptoms may include abdominal distension, bloody stools, vomiting, and lethargy
  • Diagnosis of NEC is confirmed through imaging studies and clinical findings
  • Surgical consultation is obtained for severe cases where resection of necrotic bowel is necessary

After bowel resection:

  • Infant undergoes surgical resection of necrotic bowel loops
  • Pathological examination of resected bowel reveals presence of necrotic patches in margins
  • Patients with complete resection have lower mortality rates and shorter hospital stays
  • Patients with incomplete resection have higher mortality rates and longer hospital stays
  • Combination of clinical and histopathological data improves prediction of mortality and hospital stay
  • Factors such as antenatal steroids, chorioamnionitis, and duration of post-operative ileus impact mortality prediction
  • Factors such as gestational age, depth of necrosis, and need for parenteral nutrition impact length of hospital stay.

What to Ask Your Doctor

  1. What is the reason for the bowel resection procedure?
  2. What are the potential risks and complications of the procedure?
  3. How long is the recovery process expected to take?
  4. Will there be any dietary restrictions or changes needed after the surgery?
  5. What follow-up care will be required after the procedure?
  6. How will the success of the surgery be monitored?
  7. What are the signs of complications to watch out for after the surgery?
  8. Are there any long-term effects or implications of the bowel resection?
  9. What factors can impact the outcome of the surgery, such as complete vs. incomplete resection of necrotic bowel?
  10. Are there any specific lifestyle changes or precautions that need to be taken post-surgery?

Reference

Authors: Garg PM, Bernieh A, Hitt MM, Kurundkar A, Adams KV, Blackshear C, Maheshwari A, Saad AG. Journal: Pediatr Res. 2021 Jan;89(1):163-170. doi: 10.1038/s41390-020-0975-6. Epub 2020 May 21. PMID: 32438367