Exploring Outcomes for Infants with Surgical Necrotising Enterocolitis: A Systematic Review of Surgical Interventions and Patient Characteristics Associated with Mortality

ORCID

Document Type

Article

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. Meta-analysis indicated higher mortality with peritoneal drainage compared to laparotomy (hazard ratio 4.28; 95% CI 1.62–11.27; p=0.0033). Dichotomous mortality also favoured laparotomy (log risk ratio -0.68; 95% CI -1.47 to -0.12). Surgical timing (<48h vs >48h) showed no significant difference (log odds ratio 0.32; 95% CI -0.58 to 1.22). Suspected necrosis and failed medical treatment were associated with higher mortality. Lower gestational age and birthweight consistently predicted poorer outcomes.Conclusion: Laparotomy may offer a survival advantage over peritoneal drainage; however, substantial heterogeneity limits definitive recommendations. Gestational age and birthweight remain strong prognostic indicators. Standardisation in diagnostic definitions and reporting is essential to advance evidence-based surgical guidelines.

Publication Date

2026-10-13

Publication Title

Journal of Pediatric Surgery

ISSN

0022-3468

Acceptance Date

2026-10-13

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