Necrotizing Enterocolitis
Necrotizing Enterocolitis
Necrotizing enterocolitis (NEC) is a severe bowel disease that primarily affects preterm infants. It causes inflammation and can lead to intestinal tissue death. NEC remains a major cause of illness and mortality, with about half of severe cases requiring surgery. Despite advances in neonatal care, outcomes have improved little, and treatment approaches vary across hospitals.
This thesis of Otis van Varsseveld examines surgical treatment for NEC and opportunities to improve care quality. Nationwide studies demonstrated high postoperative mortality (34–47%) and frequent complications, including bloodstream infections, stoma-related problems, and wound dehiscence. Increased mortality risk was associated with male sex, low birth weight, and the need for blood pressure support before surgery. These findings can support clinicians in counseling parents and making complex treatment decisions.
Surgical innovations were also explored. A literature review indicates that a technique using fluorescent dye to visualize intestinal blood flow is safe and may assist surgeons in more accurately determining cutting margins. In addition, artificial intelligence was applied to analyze decision making between surgery and comfort care in critically ill infants with NEC. Key factors included brain ultrasound findings, circulatory stability, and birth weight, contributing to more transparent decision making.
Finally, research and care quality were addressed. Outcome reporting appears inconsistent, and surgical practices vary internationally. Through multiple studies, international expert agreement was achieved on standardized study outcomes and quality indicators. This may improve comparability between studies and support hospitals in evaluating and improving care, ultimately aiming to enhance outcomes for infants with NEC.