Retrospective analysis of the course of ulcerative necrotizing enterocolitis in newborns (clinical cases)

Ulcerative-necrotizing enterocolitis (NEC) is one of the leading causes of mortality and urgent surgical interventions in the neonatal period. Improving diagnostic and treatment approaches for this condition remains an important and relevant objective to enhance clinical outcomes. Aim - to analyze the clinical course, diagnostic approaches, and treatment strategies for newborns with ulcerative-necrotizing enterocolitis based on retrospective analysis and selected clinical case reviews. Materials and methods. The analysis included data from 138 newborns with NEC who were treated at the departments during the period from 2013 to 2023. Of these, 34 (24.6%) underwent surgical intervention, and these cases were analyzed in more detail. A review of clinical cases of NEC in newborns was conducted. General clinical, laboratory, instrumental, histological, and statistical methods were used in the study. Results. Among the 138 infants with NEC, 104 (75.4%) patients with the stage I or II received conservative treatment, while 34 (24.6%) underwent surgical intervention. A total of 25 infants (18.1%) died. The majority of the operated patients had the stage IIIA NEC (52.9%) or the stage IIIB NEC (41.2%). In 94.1% of the operated cases, the gestational age was less than 36 weeks, and in 79.4% the birth weight was under 2000 grams. The main laboratory findings in the stage IIIB NEC included elevated leukocytosis, anemia, decreased protein and albumin levels, and increased urea levels. Ultrasound and radiographic imaging confirmed the diagnosis and associated complications. Bacteriological monitoring revealed pathogenic microflora in 85.7% of patients with the stage IIIB NEC. The main surgical interventions included laparocentesis, laparoscopy, and laparotomy. Postoperative mortality was 23.5%. Two clinical cases of NEC were reviewed, highlighting several debatable management aspects. Conclusions. Necrotizing enterocolitis (NEC) remains a severe complication of the neonatal period, requiring a multidisciplinary approach to diagnosis and treatment. The presented clinical cases demonstrate the necessity of an individualized approach to managing patients with NEC. There is no universal surgical strategy for treating NEC, further research is needed, particularly regarding the impact of maternal COVID-19 infection during pregnancy on newborns, especially concerning hemostatic disorders. This study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committee of the institution. Informed consent was obtained from all patients. The authors declare no conflict of interest.