Archives of Pediatrics (ISSN: 2575-825X)

research article

Predictors of Development and Diagnostic Delay of Post-Necrotizing Enterocolitis Strictures

Dhruvin H. Hirpara1, Arash Azin1, Chethan Sathya1, Hau D Le2, Aideen M. Moore3, Annie H. Fecteau4*

1Department of Surgery, University of Toronto, Toronto, Ontario, Canada

2Division of Pediatric Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA

3Division of Neonatology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada

4Division of General and Thoracic Surgery, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada

*Corresponding author: Annie Fecteau, Division of General and Thoracic Surgery, The Hospital for Sick Children (SickKids) 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. Tel: +14168136402; Fax: +14168137477; Email: annie.fecteau@sickkids.ca

Received Date: 15 February, 2018; Accepted Date: 21 February, 2018; Published Date: 02 March, 2018

Abstract

Objectives: To evaluate predictors of post-Necrotizing Enterocolitis (NEC) stricture development and explore the incidence, location, and time to diagnosis of post-NEC strictures at a major pediatric teaching hospital.

Methods: A retrospective review of infants from 2003-2013 was performed. Data collected included demographics, treatment type, NEC stage, time to presentation and diagnosis of strictures, and laboratory values (C-reactive protein, minimum platelet count, duration of thrombocytopenia, and pH). Univariate, Multivariate and Wilcoxon-Rank Sum testing was used to evaluate the association between variables and stricture development.

Results: A total of 175 infants with NEC were identified, of which 35 (20%)developed post-NEC strictures. Univariate analysis revealed that patients receiving laparotomy (p<0.01), with higher NEC stage (p=0.013), elevated CRP (<0.01), lower platelet counts (p=0.018), greater duration of thrombocytopenia (p=0.011) and lower blood pH (p=0.028) were at significant risk of stricture development. After multivariate analysis, however, only elevated CRP values were found to be predictive of stricture development (p<0.047). Additionally, patients with small bowel strictures took significantly longer (35 days) topresent with symptoms of obstruction than those with strictures in the large bowel (18.5 days; p=0.037). There was a trend towards delay in diagnosis of small bowel strictures, however, this difference did notachieve statistical significance (p=0.09).

Conclusions: A higher index of suspicion should be maintained for intestinal strictures in patients with advanced NEC and elevated inflammatory markers. Symptoms of obstruction may take longer to manifest in infants withsmall bowel strictures.

Keywords: Antibiotics; Necrotizing Enterocolitis; Post-NEC Stricture; Surgery


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