773 Predictive Factors of Surgery in Necrotizing Enterocolitis

Background: Previous studies have shown controversy in surgical or medical management of necrotizing enterocolitis (NEC). Objective: To study perinatal predictive factors of surgery in monocentric NEC population. Material and Methods: A retrospective study conducted in Neonatal Intensive Care unit from 1st January 2003 to the 31st December 2008. Fetal and neonatal clinical characteristics were aβeβed for 33 NEC cases, stages II or more of Bell claβification (mean GA±SD = 28.9±2.4 wks; birth weight = 1156±416 g). Data were compared between A subgroup of 11 infants with surgical management and B subgroup of 22 infants with medical management. Results: There was no significant difference in mean GA and birth-weight between A and B subgroups, respectively (27.6±2.3 vs 28.9±2.5 wks; p=0.13) and (1055±355 g vs 1208±439 g; p=0.29). NEC had occurred at 29±15.8 and 29.8±13.5 days respectively in A and B groupes, leading to death in 4/11 vs 7/22. Surgery was aβociated with high bell claβification stages [6/11 (3a) and 4/11 (3b), groupe A vs 4/22 (3a) and 1/22 (3b), groupe B; p=0.02]. Surgery was aβociated with significantly higher incidence of nosocomial infection (9/11 vs 12/22; p=0.05), antenatal mother's urinary tract infection (4/11 vs 1/22; p=0.015), dopamine use for hemodynamic disorders (8/11 vs 8/22; p=0.02) and more vaginal delivery (9/11 vs 9/22; p=0.02). Multivariate analysis showed vaginal delivery as an independent predictive factor of surgery in NEC odd ratio 25; IC 95% [1.2-520], p=0.04. Conclusion: Our study shows that surgery management of NEC was aβociated with significantly higher incidence of vaginal birth.