The bowel loss was preserved with surgical intervention based on multi-item scoring in infants with necrotizing enterocolitis

Background Necrotizing enterocolitis (NEC) is a life-threatening gastrointestinal disorder in neonates, and the optimal timing of surgical intervention for this condition remains controversial. This study aimed to determine the appropriate timing of surgery and evaluate its impact on bowel preservation in infants with NEC. Methods A multicenter retrospective study was conducted across four hospitals in Chongqing between April 2008 and January 2023. A total of 392 infants diagnosed with NEC (modified Bell stage 2 or higher) were enrolled. All participants were divided into three groups: medical management group ( n = 192), surgical group with a 13-point indicator score ≤ 5 ( n = 62), and surgical group with a score > 5 ( n = 138). The primary outcomes included postoperative intestinal stricture and total bowel resection volume. Results Infants in the score > 5 group presented with significantly lower birth weight, gestational age, and body weight at diagnosis (all P < 0.01). Compared with the score ≤ 5 group, the score > 5 group had a higher rate of bowel resection (76.1% vs. 58.1%, P < 0.001), a higher incidence of ileocecal valve resection (57.2% vs. 19.4%, P < 0.001), and a longer median length of resected bowel (19 cm vs. 8 cm, P = 0.002). The rates of intestinal stricture (42.0% vs. 17.7%) and total bowel resection (52.2% vs. 21.0%) were also markedly elevated in the score > 5 group. Additionally, this group demonstrated higher rates of 90-day parenteral nutrition dependence, prolonged neonatal intensive care unit (NICU) stay, hospital readmission, and all-cause mortality (all P < 0.05). Conclusions Surgical intervention based on multi-item scoring was independently associated with reduced bowel resection length in infants with NEC, after adjusting for baseline disease severity and neonatal baseline characteristics.