E. Pace1, P. Waltz2, T. Yanowitz3, M. Morowitz2 1University Of Pittsburgh, Department Of Surgery, Pittsburgh, PA, USA 2University Of Pittsburgh, Department Of Pediatric Surgery, Pittsburgh, PA, USA 3University Of Pittsburgh, Department Of Neonatology, Pittsburgh, PA, USA
Introduction: Surgical necrotizing enterocolitis (NEC) is associated with significant morbidity and mortality. Infants who undergo surgery for NEC are commonly administered prolonged postoperative courses of broad-spectrum antibiotics. However, recent studies have associated prolonged antibiotic use in preterm, low-birthweight neonates with poor clinical outcomes such as sepsis and death. In our scoping review we aim to provide an overview of current literature regarding optimal postoperative antibiotic management of surgical NEC and map available evidence to identify gaps in knowledge.
Methods: This protocol was developed according to recommendations provided by the PRISMA Extension for Scoping Reviews and the Joanna Briggs Institute. In July of 2022, PubMed, Cochrane CENTRAL, Google Scholar, Web of Science, and EBSCO Academic Premier databases were systematically searched. Randomized controlled trials (RCTs) and nonrandomized interventions reporting data on outcomes related to postoperative antibiotic administration following surgery for NEC were included. Reference lists of studies were also hand searched for inclusion of relevant articles.
Results: Of the 214 studies identified, 4 retrospective cohort studies were included in our scoping review. These studies included 1,107 infants diagnosed with surgical NEC and assessed antibiotic regimens and durations and their association with various clinical outcomes. Anaerobic antimicrobial therapy was associated with a decrease in mortality for infants with surgical NEC. Duration of antibiotic therapy in surgical NEC infants was associated with longer time to full feeds and length of stay. Studies noted significant variability in selection and utilization of postoperative antibiotics for infants with surgical NEC.
Conclusion: Perioperative antibiotic administration varies significantly for infants diagnosed with surgical NEC. Currently in the literature, there is limited evidence regarding postoperative antibiotic management following surgery for NEC. This review highlights the need for further prospective studies to evaluate postoperative antibiotic prescribing practices and allow for the creation of clinical guidelines to improve outcomes for infants with surgical NEC.