POST-OPERATIVE SURVIVAL IN PRETERM INFANTS WITH PAN-INTESTINAL NECROTISING ENTEROCOLITIS
ALON YULEVICH
Department of Pediatric Surgery, Western Galilee Hospital, Nahariya, Israel and Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
YECHIEL SWEED
Department of Pediatric Surgery, Western Galilee Hospital, Nahariya, Israel and Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
JEORGE G. MOGILNER
Department of Pediatric Surgery, Bnei Zion Medical Center, Haifa, Israel and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
VERED FLEISHER- SHEFFER
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and Department of Neonatology, Western Galilee Hospital, Nahariya, Israel
MORDECHAI BEN- ELISHA
Department of Neonatology, Western Galilee Hospital, Nahariya, Israel
ILAN EREZ
Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel andSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
TZVI STEINER
Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel
SHMUEL ARNON *
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel and Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
*Author to whom correspondence should be addressed.
Abstract
Introduction: Necrotizing enterocolitis (NEC) is one of the most severe complications among preterm infants. High mortality is reported in multifocal or pan-intestinal disease. Deaths from pan-intestinal disease occur following a decision to withhold or withdraw intensive care or from multi-organ failure.
Aim: To evaluate the outcome of preterm infants who had pan-intestinal disease, where withholding or withdrawing treatment was not an option because of cultural and religious constraints.
Methods: The records of all preterm infants born in three different medical centers between January 1, 2000 and December 31, 2013, who suffered from pan-necrotizing enterocolitis diagnosed during surgery, were reviewed for length of survival and post-operative complications.
Results: Six premature infants were identified and characterized. All died 16 to 253 days after delivery. They were treated with ventilation, antibiotics, and total parental nutrition. Four infants underwent successful extubation. Cause of death was either sepsis or multi-organ failure.
Conclusions: Preterm infants with pan-necrotizing enterocolitis have poor prognosis, even when treated intensively. Survival more than 2 weeks does not alter the poor prognosis, and medical and surgical treatments seem futile.
Keywords: Necrotizing enterocolitis (NEC), near-total-gut necrosis, futile treatment, preterm infant, surgical dilemmas