SURGICAL STRATEGIES IN VERY-LOW-BIRTH-WEIGHT NEONATES WITH NECROTIZING ENTEROCOLITIS

Very-low-birthweight (VLBW) neonates are more prone to complications a nd death than term infants are. In a 15-year period, 19 neonates with VLBW were operated on for necrotizing enterocolitis (NEC). Indications for operation were pneumoperitoneum in 12 and deterioration of genera l condition in 7. Bowel resection and intestinal diversion was perform ed in 12, a lateral enterostomy at the site of perforation was created in 5, and 2 neonates with necrosis of the whole bowel underwent an ex ploratory laparotomy without any further surgical treatment. Surgical complications were found in one-third of the patients. The mortality r ate was significantly higher when the ileum was affected. The survival rate was 68%. Prior to 1984 the survival rate was 37% (3/8); subseque ntly, it has improved to 91% (10/11) as a result of improved intensive therapy,