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American Academy of Pediatrics
Article

Surgical Necrotizing Enterocolitis

A Primer for the Neonatologist

Mehul V. Raval and R. Lawrence Moss
NeoReviews August 2013, 14 (8) e393-e401; DOI: https://doi.org/10.1542/neo.14-8-e393
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Mehul V. Raval
*Division of Pediatric Surgery, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH.
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R. Lawrence Moss
*Division of Pediatric Surgery, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH.
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  • Abbreviations:
    NEC,
    necrotizing enterocolitis
    NICHD,
    National Institute of Child Health and Human Development
    PPD,
    primary peritoneal drainage
  • Abstract

    Necrotizing enterocolitis (NEC) is the most common surgical emergency among NICU patients. Patients with NEC requiring surgical intervention have the highest morbidity and mortality and accrue the highest costs. The objective of this review is to provide the neonatologist with an overview of options available for the surgical management of this complex and potentially devastating disease. When evaluating patients with NEC, surgical intervention is reserved for those patients with pneumoperitoneum, confirmed stool or pus in the peritoneal cavity, or worsening clinical status. Options range from peritoneal drain placement to laparotomy with enterostomy creation, anastomoses, or temporizing measures with planned second-look operations. The choice of operation has not been shown to have a significant effect on any clinically important outcomes. The mortality rate for surgically managed NEC remains dependent upon the severity of disease and is directly correlated to gestational age.

    • Copyright © 2013 by the American Academy of Pediatrics

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    NeoReviews
    Vol. 14, Issue 8
    1 Aug 2013
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    Surgical Necrotizing Enterocolitis
    Mehul V. Raval, R. Lawrence Moss
    NeoReviews Aug 2013, 14 (8) e393-e401; DOI: 10.1542/neo.14-8-e393

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    Surgical Necrotizing Enterocolitis
    Mehul V. Raval, R. Lawrence Moss
    NeoReviews Aug 2013, 14 (8) e393-e401; DOI: 10.1542/neo.14-8-e393
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    • Article
      • Abstract
      • Educational Gap
      • Learning Objectives
      • Introduction
      • Clinical Presentation and Evaluation
      • Laparotomy Versus Peritoneal Drainage
      • Other Surgical Options
      • Complications of Surgical Intervention
      • Conclusions
      • Footnotes
      • References
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