Treatment

Given the difficulty of a definitive diagnosis in cases of medically managed NEC, discussion of treatment options at SIGNEC meetings has focused on surgical management. A number of procedures are performed by various institutions and surgeons, but there is no general agreement on the optimal intervention and we need more information to inform surgical decision-making. As babies who survive surgical NEC are at high risk of short bowel syndrome and neurodevelopmental impairment, new preventive approaches are needed to reduce the need for surgery and to improve outcomes.

In the Role of ultrasound in surgical decision making for NEC, Professor Nigel Hall, Consultant Paediatric and Neonatal Surgeon at Southampton Children’s Hospital, suggested that there are few, if any, other surgical conditions where we wait for the endpoint of the disease process to become evident before offering surgical intervention. To identify sooner infants with critical intestinal ischaemia or necrosis, we need more research on intestine-specific biomarkers. But we do have a readily available tool in ultrasound, and Professor Hall presented findings from an evaluation of its usefulness which concluded that ultrasound accurately identified infants with established NEC and necrotic bowel.

As no studies of laparotomy and peritoneal drainage had used neurodevelopmental impairment as an outcome measure, and drainage is now used more frequently in the US, Professor Gail E. Besner of Nationwide Children’s Hospital in Columbus, Ohio, explained that this was part of the rationale for a randomised controlled trial begun 7 years ago, which has involved 19 clinical sites. In Introduction to the NEST trial, she reported that more than 300 ELBW infants with operative NEC or intestinal perforation will have had an extensive neurodevelopmental assessment at 2 years of age, and are likely to significantly influence the surgical treatment of NEC patients in the future.