{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T20:34:53Z","timestamp":1773693293007,"version":"3.50.1"},"reference-count":40,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T00:00:00Z","timestamp":1691452800000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["World Jnl Ped Surgery"],"accepted":{"date-parts":[[2023,7,17]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The aim of this study was to identify the state of surgical treatment of neonatal necrotizing enterocolitis (NEC) in China.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A total of 246 delegates (88.0% senior surgeons) completed a survey sent by the Neonatal Surgery Group of the Pediatric Surgery Branch of the Chinese Medical Association in 2022. Five centers were eliminated due to lack of experience.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Generally, 38.2% of surgeons work in centers where more than 20 cases of surgical NEC are treated per year. A total of 81.3% of surgeons reported the use of ultrasonography; the most used biomarkers were white blood cell count (95.9%), C-reactive protein (93.8%), and procalcitonin (76.3%). Most surgeons (80.9%) used a combination of two (67.2%) antibiotics or single (29.5%) antibiotic for a treatment period of 7\u201314 days, and most used antibiotics were carbapenems (73.9%), penicillin and cephalosporins (56.0%). Patients are issued the fasting order for 5\u20137\u2009days by nearly half surgeons (49.8%) for conservative treatment. 70.1% of surgeons deemed that the most difficult decision was to evaluate the optimal timing of surgery. Most surgeons (76.3%) performed diagnostic aspiration of peritoneal fluid. Laparoscopy was performed for the diagnosis and\/or treatment of NEC by 40.2% of surgeons. A total of 53.5% of surgeons reported being able to identify localized intestinal necrosis preoperatively. Surgeons relied the most on pneumoperitoneum (94.2%) and failure of conservative treatment (88.8%) to evaluate the surgical indications. At laparotomy, surgical treatments vary according to NEC severity. Infants are fasted for 5\u20137\u2009days by 55.2% of surgeons postoperatively. Most surgeons (91.7%) followed up with patients with NEC after discharge for up to 5 years (53.8%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The most difficult aspect of surgical NEC is evaluating the timing of surgery, and surgeons in the children\u2019s specialized hospitals are experienced. The treatment of NEC totalis is controversial, and the indications for laparoscopy need to be further clarified. More multicenter prospective studies are needed to develop surgical guidelines in the future.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/wjps-2023-000588","type":"journal-article","created":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T06:20:14Z","timestamp":1694067614000},"page":"e000588","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Survey on surgical treatment of neonatal necrotizing enterocolitis in China 2022"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4155-3245","authenticated-orcid":false,"given":"Jiafang","family":"Gao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dengming","family":"Lai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinfa","family":"Tou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,8,8]]},"reference":[{"key":"2025081809571342000_6.4.e000588.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1005408"},{"key":"2025081809571342000_6.4.e000588.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2013.11.015"},{"key":"2025081809571342000_6.4.e000588.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2020.02.046"},{"key":"2025081809571342000_6.4.e000588.4","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1055\/s-0039-3400514","article-title":"The development of necrotizing Enterocolitis publications: A Holistic evolution of global literature with Bibliometric analysis","volume":"30","author":"Do\u011fan","year":"2020","journal-title":"Eur J Pediatr Surg"},{"key":"2025081809571342000_6.4.e000588.5","first-page":"27","article-title":"International survey on the management of necrotizing Enterocolitis. European Journal of pediatric surgery: official Journal of Austrian Association of pediatric surgery","volume":"25","author":"Zani","year":"2015","journal-title":"Z Kinderchir"},{"key":"2025081809571342000_6.4.e000588.6","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.080372"},{"key":"2025081809571342000_6.4.e000588.7","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.jpedsurg.2009.10.069","article-title":"Timing of surgical intervention in necrotizing Enterocolitis can be determined by trajectory of metabolic derangement","volume":"45","author":"Tepas","year":"2010","journal-title":"Journal of Pediatric Surgery"},{"key":"2025081809571342000_6.4.e000588.8","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/j.jamcollsurg.2010.01.008","article-title":"Trajectory of metabolic derangement in infants with necrotizing Enterocolitis should drive timing and technique of surgical intervention","volume":"210","author":"Tepas","year":"2010","journal-title":"J Am Coll Surg"},{"key":"2025081809571342000_6.4.e000588.9","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2018-316263"},{"key":"2025081809571342000_6.4.e000588.10","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1007\/s00247-021-05187-5","article-title":"The role of ultrasound in necrotizing Enterocolitis","volume":"52","author":"Hwang","year":"2022","journal-title":"Pediatr Radiol"},{"key":"2025081809571342000_6.4.e000588.11","doi-asserted-by":"crossref","first-page":"976","DOI":"10.2214\/AJR.17.19378","article-title":"Neonatal bowel disorders: practical imaging algorithm for Trainees and general Radiologists","volume":"210","author":"Ngo","year":"2018","journal-title":"AJR Am J Roentgenol"},{"key":"2025081809571342000_6.4.e000588.12","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1055\/a-0879-8110","article-title":"Sonographic and doppler sonographic diagnosis of necrotizing enterocolitis in preterm infants and newborns","volume":"40","author":"Deeg","year":"2019","journal-title":"Ultraschall in Med"},{"key":"2025081809571342000_6.4.e000588.13","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1007\/s00431-021-04339-x","article-title":"Hyponatremia at the onset of necrotizing Enterocolitis is associated with intestinal surgery and higher mortality","volume":"181","author":"Palleri","year":"2022","journal-title":"Eur J Pediatr"},{"key":"2025081809571342000_6.4.e000588.14","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.siny.2018.07.006","article-title":"An update on biomarkers of necrotizing Enterocolitis","volume":"23","author":"Ng","year":"2018","journal-title":"Seminars in Fetal and Neonatal Medicine"},{"key":"2025081809571342000_6.4.e000588.15","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.clp.2021.11.011","article-title":"Biomarkers of necrotizing Enterocolitis: the search continues","volume":"49","author":"Gunasekaran","year":"2022","journal-title":"Clin Perinatol"},{"key":"2025081809571342000_6.4.e000588.16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1067\/j.cpsurg.2018.11.005","article-title":"Current status of necrotizing Enterocolitis","volume":"56","author":"Knell","year":"2019","journal-title":"Curr Probl Surg"},{"key":"2025081809571342000_6.4.e000588.17","doi-asserted-by":"crossref","first-page":"151326","DOI":"10.1016\/j.semperi.2020.151326","article-title":"Infection control and other stewardship strategies in late onset sepsis, necrotizing Enterocolitis, and localized infection in the neonatal intensive care unit","volume":"44","author":"Aleem","year":"2020","journal-title":"Semin Perinatol"},{"key":"2025081809571342000_6.4.e000588.18","doi-asserted-by":"publisher","DOI":"10.1542\/pir.2017-0338"},{"key":"2025081809571342000_6.4.e000588.19","article-title":"Antibiotic regimens for the empirical treatment of newborn infants with necrotizing Enterocolitis","volume":"2012","author":"Shah","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"2025081809571342000_6.4.e000588.20","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1016\/j.jpedsurg.2018.02.082","article-title":"Time to reintroduction of feeding in infants with Nonsurgical necrotizing Enterocolitis","volume":"53","author":"Arbra","year":"2018","journal-title":"J Pediatr Surg"},{"key":"2025081809571342000_6.4.e000588.21","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1038\/s41372-020-0722-1","article-title":"Earlier Reinitiation of Enteral feeding after necrotizing Enterocolitis decreases recurrence or Stricture: a systematic review and meta-analysis","volume":"40","author":"Patel","year":"2020","journal-title":"J Perinatol"},{"key":"2025081809571342000_6.4.e000588.22","first-page":"724","article-title":"Expert consensus on surgical treatment of neonatal necrotizing Enterocolitis","volume":"37","year":"2016","journal-title":"Chinese Journal of Pediatric Surgery"},{"key":"2025081809571342000_6.4.e000588.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2004.02.006"},{"key":"2025081809571342000_6.4.e000588.24","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1089\/lap.2018.0180","article-title":"Laparoscopy to assist surgical decisions related to necrotizing Enterocolitis in Preterm neonates","volume":"30","author":"Knudsen","year":"2020","journal-title":"Journal of Laparoendoscopic & Advanced Surgical Techniques"},{"key":"2025081809571342000_6.4.e000588.25","doi-asserted-by":"publisher","DOI":"10.1177\/1553350616646476"},{"key":"2025081809571342000_6.4.e000588.26","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1177\/000313481508100521","article-title":"Timing of optimal surgical intervention for neonates with necrotizing Enterocolitis","volume":"81","author":"Munaco","year":"2015","journal-title":"Am Surg"},{"key":"2025081809571342000_6.4.e000588.27","doi-asserted-by":"crossref","first-page":"2593","DOI":"10.1007\/s00431-022-04454-3","article-title":"Initial surgical treatment of necrotizing Enterocolitis: a meta-analysis of peritoneal drainage versus Laparotomy","volume":"181","author":"Li","year":"2022","journal-title":"Eur J Pediatr"},{"key":"2025081809571342000_6.4.e000588.28","doi-asserted-by":"crossref","first-page":"e370","DOI":"10.1097\/SLA.0000000000005099","article-title":"Initial Laparotomy versus peritoneal drainage in extremely low birthweight infants with surgical necrotizing Enterocolitis or isolated intestinal Perforation: A multicenter randomized clinical trial","volume":"274","author":"Blakely","year":"2021","journal-title":"Ann Surg"},{"key":"2025081809571342000_6.4.e000588.29","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.1016\/j.jpedsurg.2013.08.006","article-title":"Royal Australasia of Surgeons guest lecture. necrotizing Enterocolitis: prevention, treatment, and outcome","volume":"48","author":"Hall","year":"2013","journal-title":"J Pediatr Surg"},{"key":"2025081809571342000_6.4.e000588.30","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.jpedsurg.2017.01.044","article-title":"Loop versus divided Colostomy for the management of Anorectal malformations: a systematic review and meta-analysis","volume":"52","author":"Youssef","year":"2017","journal-title":"Journal of Pediatric Surgery"},{"key":"2025081809571342000_6.4.e000588.31","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1089\/lap.2018.0185","article-title":"Outcomes of Ostomy location in children: placement of the Ostomy at the Umbilicus","volume":"29","author":"Sujka","year":"2019","journal-title":"Journal of Laparoendoscopic & Advanced Surgical Techniques"},{"key":"2025081809571342000_6.4.e000588.32","first-page":"563","article-title":"Expert consensus on clinical treatment of neonatal necrotizing Enterocolitis after Enterostomy","volume":"37","year":"2016","journal-title":"Chinese Journal of Pediatric Surgery"},{"key":"2025081809571342000_6.4.e000588.33","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.gtc.2019.08.004","article-title":"Predictors of intestinal adaptation in children","volume":"48","author":"Venick","year":"2019","journal-title":"Gastroenterol Clin North Am"},{"key":"2025081809571342000_6.4.e000588.34","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1146\/annurev-animal-020518-115142","article-title":"Translational advances in pediatric nutrition and Gastroenterology: new insights from pig models","volume":"8","author":"Burrin","year":"2020","journal-title":"Annu Rev Anim Biosci"},{"key":"2025081809571342000_6.4.e000588.35","doi-asserted-by":"crossref","first-page":"151546","DOI":"10.1016\/j.semperi.2021.151546","article-title":"Gastrointestinal and feeding issues for infants <25 weeks of gestation","volume":"46","author":"Patton","year":"2022","journal-title":"Semin Perinatol"},{"key":"2025081809571342000_6.4.e000588.36","doi-asserted-by":"crossref","first-page":"2482","DOI":"10.1007\/s00268-020-05530-1","article-title":"Consensus guidelines for perioperative care in neonatal intestinal surgery: enhanced recovery after surgery (ERAS\u00ae) society recommendations","volume":"44","author":"Brindle","year":"2020","journal-title":"World J Surg"},{"key":"2025081809571342000_6.4.e000588.37","doi-asserted-by":"crossref","DOI":"10.3390\/nu13020340","article-title":"Optimizing nutritional strategies to prevent necrotizing Enterocolitis and growth failure after bowel resection","volume":"13","author":"Moschino","year":"2021","journal-title":"Nutrients"},{"key":"2025081809571342000_6.4.e000588.38","doi-asserted-by":"publisher","DOI":"10.3945\/an.116.013193"},{"key":"2025081809571342000_6.4.e000588.39","doi-asserted-by":"crossref","DOI":"10.3390\/nu12020520","article-title":"Nutrition in necrotizing Enterocolitis and following intestinal resection","volume":"12","author":"Ou","year":"2020","journal-title":"Nutrients"},{"key":"2025081809571342000_6.4.e000588.40","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2022-056445","article-title":"Long-term outcome of necrotizing Enterocolitis and spontaneous intestinal Perforation","volume":"150","author":"Vaidya","year":"2022","journal-title":"Pediatrics"}],"container-title":["World Journal of Pediatric Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/wjps-2023-000588","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T16:57:22Z","timestamp":1755536242000},"score":1,"resource":{"primary":{"URL":"https:\/\/wjps.bmj.com\/lookup\/doi\/10.1136\/wjps-2023-000588"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8]]},"references-count":40,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,8,8]]},"published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1136\/wjps-2023-000588"],"URL":"https:\/\/doi.org\/10.1136\/wjps-2023-000588","relation":{},"ISSN":["2516-5410"],"issn-type":[{"value":"2516-5410","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8]]}}}