Exploring Outcomes for Infants with Surgical Necrotising Enterocolitis: A Systematic Review of Surgical Interventions and Patient Characteristics Associated with Mortality
In brief
Peritoneal drainage was linked to 4-fold higher mortality than laparotomy
Across 29 studies of infants operated on for necrotising enterocolitis or intestinal perforation, pooled results linked peritoneal drainage with higher mortality than laparotomy. The comparison is uncertain because studies varied widely and sicker infants may have been more likely to receive drainage; the review found no clear timing effect, while lower gestational age and birthweight consistently predicted poorer outcomes.
- Journal
- Journal of pediatric surgery (Q1)
- Published
- 26 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ana Guillot Lozano, Antony Laviola, Joanne Hosking, Keith Walker, Lisa Bunn
- PMID
- 42933558
- DOI
- 10.1016/j.jpedsurg.2026.163545
Why clinicians should know about it
- Picked for Pediatric Surgery (paper of the day, 27 October 2026): Systematic review of operative strategies and mortality in neonatal NEC
Abstract
BACKGROUND: Surgical necrotising enterocolitis (sNEC) and spontaneous intestinal perforation (SIP) remain leading causes of neonatal morbidity and mortality. However, evidence on the optimal surgical strategy and the combined impact of clinical and surgical factors remains limited. OBJECTIVE: To systematically assess the association between surgical approach, timing, indications, gestational age, birthweight, and SIP diagnosis on mortality in infants undergoing surgery for sNEC or SIP. METHODS: A systematic review following PRISMA guidelines was conducted, using a registered protocol. Databases were searched to February 2025. Twenty-nine studies (two randomised controlled trials, twenty-seven observational) were included. Mortality data were synthesised through random-effects meta-analyses when appropriate; otherwise, narrative synthesis was applied. RESULTS: Laparotomy was the most frequent surgical approach. Pooled analysis indicated higher mortality with peritoneal drainage than with laparotomy (hazard ratio, 4.28; 95% CI, 1.62 to 11.27; p=0.0033). Dichotomous mortality also favoured laparotomy (log risk ratio 0.52; 95% CI -0.08 to 1.12). However, interpretation was limited by substantial heterogeneity and likely confounding by indication. Surgical timing data available for synthesis (<48h vs >48h) showed no significant difference (log odds ratio 0.16; 95% CI -7.41 to 7.74). Nonetheless, timing constructs varied across studies and were not clinically equivalent, limiting more extensive synthesis. Suspected necrosis and failed medical treatment were associated with higher mortality. Lower gestational age and birthweight consistently predicted poorer outcomes. CONCLUSION: Current evidence does not establish the superiority of one operative strategy over another. Rather, it suggests that mortality in sNEC and SIP is influenced by interacting patient, disease, and operative factors that were inconsistently reported across studies. Gestational age and birthweight remain strong prognostic indicators. Standardised definitions and data collection are therefore needed to support future adjusted analyses and more informative comparative evidence.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.