Twenty Years Experience of Bell’s Stage 3b Necrotizing Enterocolitis—A Single Center Study

Abstract

Objective

To analyze 20 years of experience of Bell’s stage 3b necrotizing enterocolitis (NEC) from a single center.

Methods

A total of 57 Bell’s stage 3b NEC cases were included in this study. The clinical records, operative findings, and outcomes of babies admitted to the neonatal intensive care unit (NICU) were tabulated and recorded retrospectively in the EXCEL database. All deaths and leaves against medical advice were recorded, and clinical outcomes at day 30 and 1 year post-operative were recorded.

Results

The mean gestational age (GA) and mean birth weight of the mortality group were 30 ± 3.5 weeks and 1.105 ± 0.479 kg, respectively. The most common surgery performed in the mortality group was subtotal colectomy with ileostomy (31%). The day 30 (D30) and 1 year (D365) post-operative mortality were 24.5% and 28%, respectively. The most common complication post-surgery was short bowel syndrome (100%) and failure to thrive (43.9%). Klebsiella was the most common growth in blood culture in both survivor and mortality groups. After 1 year, 14.2% had moderate to severe, and 4.76% had mild developmental delay as per the Development Assessment Scale for Indian Infants (DASII), despite several days of ventilator requirement with inotropes in almost all babies. At the end of 1 year, 72% of babies who underwent surgery for this common, disastrous emergency in neonatal practice were alive and thriving.

Conclusion

This study reflects the outcome of severe NEC from an Indian university teaching center in neonatology and compares favorably with several landmark articles from the Western world.