Management of necrotizing enterocolitis: Experience at a tertiary care hospital in Oman

Introduction: Necrotizing enterocolitis (NEC) is the most common surgical emergency in the neonatal intensive care unit. The aim of this study was to determine the incidence of NEC and identify the factors predicting the surgical management and also to determine the mortality due to NEC at our tertiary care neonatal unit in Oman. Materials and methods: The parameters studied included sex-based differences, gestational age at birth, birth weight, maternal risk factors, patient risk factors, age when feeding was started, type of feed, age when signs of NEC appeared, presence of any antecedent associations, clinical features, radiological features, blood investigations, requirement of surgery, surgical findings, and outcome. Results: The study included 14 male and 12 female neonates. The mean gestational age at birth was 29.8±3.7 weeks (range: 25-38 weeks). The mean birth weight was 1348.4±774.1g (range: 610-3900 g). The total incidence of NEC was 2.28%, whereas its incidence in neonates with birth weight less than 2500g was 4.47%. Surgical management was carried out for 11 (42.3%) patients. The mean platelet count in patients managed surgically was significantly lower compared with those managed conservatively (106.5 vs. 218.1 cells/μl of blood, P<0.05). Similarly, the mean C-reactive protein level was also higher in patients managed surgically compared with those managed conservatively (104 vs. 54 mg%, respectively, P<0.05). Five of 26 (19.2%) patients died during the course of treatment. Conclusion: The incidence and mortality rate of NEC in Oman is similar to that in other countries. Low platelet counts and high C-reactive protein levels are the factors that can predict the need for surgical management.