{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:56:17Z","timestamp":1792180577661,"version":"4.4.0"},"reference-count":51,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"vor","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In infants born at &amp;lt; 26 weeks of gestational age (wGA) who develop necrotizing enterocolitis (NEC), medical and ethical considerations about whether surgery is the optimal treatment are complicated by a lack of group-specific outcome data. This study investigated nationwide 30-day mortality, surgical complications, and preoperative mortality risk factors in infants born at &amp;lt; 26 wGA who underwent surgery during the active phase of NEC.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective nationwide multicentre study included all infants born at &amp;lt; 26 wGA undergoing surgery for Bell\u2019s stage II\/III NEC in the Netherlands between 2008 and 2022, regardless of outcome. Severe NEC was defined as Bell\u2019s stage III (confirmed by laparotomy and\/or leading to death). The primary outcome was postoperative 30-day mortality. The incidence of major postoperative complications (Clavien\u2013Madadi III\u2013IV) was determined after excluding infants undergoing open\u2013close procedures for massive bowel necrosis. Potential risk factors for death after surgery were assessed using multivariable logistic regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 288 infants with NEC Bell\u2019s stage \u2265 II, 80 (27.8%) survived without surgery, 66 (22.9%) died before laparotomy, and 142 (49.3%) underwent laparotomy. In 142 surgically treated infants with severe NEC (57.0% male), the median gestational age was 25 + 0 (range 23 + 6 to 25 + 6) weeks + days, the median birthweight was 750 (range 485\u20131070) g, and the median age at surgery was 14 (range 2\u201366) days. Primary open\u2013close surgery was performed in 34 of 142 infants (23.9%). In the remaining 108 infants, surgical management included stoma creation (63.0%), primary anastomosis (27.8%), or both (9.3%). Overall, the 30-day mortality rate among 142 infants was 47.2% (67 deaths). Death occurred after a primary or second-look open\u2013close procedure in 37 infants, after multiorgan failure in 17, and from other causes in the remaining 13. After excluding 37 infants who died after open\u2013close procedures, 30-day complications occurred in 23 (21.9%) of 105 surgically treated infants. There were 29 events in total, including reoperation for bowel perforation (5, 17%) or anastomotic leak\/stenosis (5, 17%). Regression analysis identified no risk factors for 30-day mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The 30-day mortality rate was 47.2% in infants born at &amp;lt; 26 wGA undergoing NEC surgery, most of whom died after an open\u2013close procedure. Another 21.9% of infants experienced major complications.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjsopen\/zraf060","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T13:39:03Z","timestamp":1748007543000},"source":"Crossref","is-referenced-by-count":4,"title":["Surgical outcomes for necrotizing enterocolitis in Dutch infants born before 26 weeks\u2019 gestation"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8764-7744","authenticated-orcid":false,"given":"Otis C","family":"van Varsseveld","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Pediatric Surgery, University Medical Center Groningen, University of Groningen , Groningen ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adinda G H","family":"Pijpers","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Emma Children\u2019s Hospital, Amsterdam University Medical Centers, University of Amsterdam and Vrije Universiteit , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ceren","family":"Imren","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Sophia Children\u2019s Hospital, Erasmus Medical Center, Erasmus University , Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joep P M","family":"Derikx","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Emma Children\u2019s Hospital, Amsterdam University Medical Centers, University of Amsterdam and Vrije Universiteit , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5494-730X","authenticated-orcid":false,"given":"Chris H P","family":"van den Akker","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\u2014Neonatology, Emma Children\u2019s Hospital, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Centers, University of Amsterdam and Vrije Universiteit , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost","family":"van Schuppen","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia M G","family":"Keyzer-Dekker","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Sophia Children\u2019s Hospital, Erasmus Medical Center, Erasmus University , Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marijn J","family":"Vermeulen","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Neonatal Intensive Care, Division of Neonatology, Sophia Children\u2019s Hospital, Erasmus Medical Center, Erasmus University , Rotterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten","family":"Schurink","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Amalia Children\u2019s Hospital, Radboudumc, Radboud University , Nijmegen ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maud Y A","family":"Lindeboom","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht , Utrecht ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth M W","family":"Kooi","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Beatrix Children\u2019s Hospital, University Medical Center Groningen, University of Groningen , Groningen ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan B F","family":"Hulscher","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Pediatric Surgery, University Medical Center Groningen, University of Groningen , Groningen ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"key":"2025052309385798600_zraf060-B1","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.jpedsurg.2016.11.024","article-title":"Increased incidence of necrotizing enterocolitis in the Netherlands after implementation of the new Dutch guideline for active treatment in extremely preterm infants: results from three academic referral centers","volume":"52","author":"Heida","year":"2017","journal-title":"J Pediatr 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