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More than a gut feeling: predicting surgical necrotising enterocolitis
  1. Jörn-Hendrik Weitkamp
  1. Correspondence to Dr Jörn-Hendrik Weitkamp, Division of Neonatology, Department of Paediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2215 B Garland Ave., 1125 MRB IV/Light Hall, Nashville, TN 37232-0656, USA; hendrik.weitkamp{at}

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Despite recent advances in neonatal practice, necrotising enterocolitis (NEC) remains the most common and devastating gastrointestinal emergency in premature infants. In fact, as more extremely premature infants survive, the incidence appears to be increasing worldwide.1 Severe NEC is characterised by coagulative necrosis of the distal ileum and proximal colon with clinical presentation ranging from abdominal distension, pneumatosis intestinalis, frank blood in stools, intestinal gangrene, bowel perforation, sepsis and shock. Approximately 9000 infants develop NEC in the USA each year and mortality rates range from 10%–50%.2 ,3 The associated costs—both financial and personal—are significant; the average hospital stay for infants with surgical NEC is an additional 43.1 days at an average additional cost of US$200 000 per child compared with extremely low birthweight infants without NEC.4 Treatment strategies are mainly supportive and include administration of antibiotics and fluids, blood product replacement and withholding of feedings. About 40% of NEC patients require surgery to remove necrotic bowel, which can result in short bowel syndrome, with prolonged medical expenses and chronic gastrointestinal difficulties. In particular, surgical NEC is a significant predictor of lasting neurodevelopmental morbidity independent of other factors.5 ,6 While the outcomes for many prematurity-related illnesses have improved over the past decades, mortality and …

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