Outcomes of diverting jejunostomy for severe necrotizing enterocolitis.

BACKGROUND/PURPOSE: A diverting jejunostomy without bowel resection is an option for surgical management of extensive necrotizing enterocolitis (NEC). We aimed to determine outcomes of infants who underwent this operation. METHODS: We collected clinical and outcome data on infants undergoing a diverting jejunostomy with no bowel resection as a primary procedure for extensive NEC. Data are median (range). RESULTS: Seventeen neonates underwent a diverting jejunostomy. Eleven (65%) had multifocal disease, whereas 6 (35%) had pan-intestinal involvement. Perforation was seen in 7 (41%), all with multifocal disease. The stoma was placed 12 cm (8-45) from the duodenojejunal flexure. Six infants (35%) died, 4 of these within a day of operation, owing to persisting instability. Intestinal continuity was achieved in all survivors after 52 (17-83) days, and only 1 infant (9%) had a colonic stricture. Seven infants recovered without the need for further intestinal resection distal to the jejunostomy. In those that survived, parenteral nutrition was needed for 2.2 months (1.3-18.0). A single patient had short bowel syndrome. CONCLUSIONS: A diverting jejunostomy is a useful surgical procedure that allows high survival and enteral autonomy in the treatment of extensive NEC. In most patients, the affected intestine recovers without further intestinal resection.

Is necrotizing enterocolitis associated with development or progression of intraventricular hemorrhage?

An association between necrotizing enterocolitis (NEC) and poor neurodevelopmental outcome is increasingly recognized. A progression of preexisting intraventricular hemorrhage (IVH) or new IVH during an episode of NEC may be contributory. We investigated the incidence of IVH in infants with NEC. We performed an observational study of 105 infants with acute NEC during a 3-year period. Cranial ultrasound scans were performed on admission, following surgery, and following periods of clinical instability. Median birth weight was 0.92 kg (interquartile range, 0.73 to 1.56), gestational age 27 weeks (interquartile range, 25 to 30), and age at admission 14 days (interquartile range, 6 to 32). Twenty-five infants had an IVH before developing NEC. Eighty-one had Bell stage III disease, and 84 required surgery. Four infants developed a new IVH during the episode of NEC and all four died. IVH during an episode of NEC is rare even in very sick babies but carries a poor prognosis. IVH during an episode of NEC is unlikely to account for the poor neurodevelopmental outcome in this group as a whole.