Outcome of very premature infants with necrotising enterocolitis cared forin centres with or without on site surgical facilities

Objective-To determine if the presence of a neonatal surgical facility on s ite has any effect on mortality and morbidity of very premature infants wit h necrotising enterocolitis (NEC). Design and Setting-Retrospective review of infants of less than 29 weeks ge station cared for in the seven perinatal centres in New South Wales. Patients-Between 1992 and 1997, 605 infants were cared for in two centres w ith in house surgical facilities (group 1) and 1195 in five centres where t ransfers were required for surgical management (group 2). Results-Although use of antenatal steroids was significantly lower in group 1 centres than group 2 centres (74% v 85% respectively), and the incidence of hyaline membrane disease, pneumothorax, and NEC was higher, mortality w as identical (27%). Fifty two (9%) infants in group 1 and 72 (6%) in group 2 of comparable perinatal characteristics and CRIB (Clinical Risk Index for Babies) scores developed radiologically or pathologically proven NEC. The overall mortality of infants with NEC in group 1 was lower but this was not statistically significant (27% v 35%). Significantly more infants with NEC in group 1 had surgery (69% v 39%). There were fewer postoperative deaths in group 1 and more deaths without surgery in group 2. The duration of resp iratory and nutritional support and hospital stay for the survivors were si milar in the two groups. In a multivariate analysis, shorter gestation was the only factor associated with mortality in infants with NEC; the presence of in house surgical facilities was not. Conclusions-There were no significant differences in outcome of premature i nfants with NEC managed in perinatal centres with or without on site surgic al facilities. Early transfers should be encouraged. This finding may have implications for future planning of facilities for neonatal care.