Is Necrotizing Enterocolitis Totalis a Distinct Disease Process?

PURPOSE: This study aimed to characterize the clinical features of necrotizing enterocolitis totalis (NEC-T) in infants compared with NEC non-totalis (NEC-non-T) and to identify associated risk factors, thereby providing insights into its management for clinicians and parents.

METHODS

A retrospective study was conducted at the Guangzhou Women and Children's Medical Centre and included infants with Bell's Stage II or III NEC from January 2015 to March 2021. Infants were divided into NEC-T and NEC-non-T groups based on intraoperative findings. Clinical data were collected and compared between the two groups. Logistic regression was used to identify independent risk factors for NEC-T.

RESULTS

Among 195 infants who underwent surgery for NEC, 30 (15.4%) had NEC-T. Significant differences were observed in gestational age, time from onset to surgery (8 hours vs. 46 hours, p<0.001), survival, and intestinal failure. Risk factors for NEC-T included neonatal respiratory distress syndrome (NRDS) (OR, 12.85; p=0.004), ventilatory support after birth (OR, 13.36; p<0.001), bacteremia (odds ratio [OR], 10.98; p<0.001), transfusion (OR, 4.62; p=0.004), increased ventilatory support (OR, 7.34; p=0.001), and portal venous gas (PVG) (OR, 4.78; p=0.007).

CONCLUSION

NEC-T in neonates is characterized by sudden onset, rapid progression, and high mortality. NRDS, ventilatory support after birth, bacteremia, transfusion, increased ventilatory support, and PVG significantly increased the risk of NEC-T. Aggressive surgical decision-making may be a crucial approach to improving survival rates in patients with NEC-T.