Comparative Study Between Medically Managed and Surgically Managed Necrotising Enterocolitis in Preterm Infants: A Retrospective Cohort Study

Introduction: Necrotising enterocolitis (NEC) is a severe gastrointestinal disease predominantly affecting premature neonates. Earlier identification of infants who are likely to require surgical intervention remains challenging. This study compared medically and surgically managed NEC in preterm infants to identify clinical, biochemical, microbiological, and radiological markers associated with surgical management, disease severity, and mortality. Methods: This retrospective cohort study was conducted at St Mary’s Hospital, Manchester, using electronic patient records of infants diagnosed with NEC between January 2023 and December 2024. Infants were classified as having medically or surgically managed NEC. Demographic, biochemical, microbiological, radiological, and outcome variables were analysed. Statistical analyses included the Mann-Whitney U test, chi-square or Fisher’s exact tests, Spearman’s correlation, and logistic regression. A sensitivity analysis restricted to infants with Bell Stage II/III NEC was also performed. Results: A total of 87 infants were included, comprising 42 with medically managed NEC and 45 with surgically managed NEC. Surgically managed infants had significantly higher lactate levels (p = 0.028), lower base excess (p = 0.025), and a greater frequency of pneumoperitoneum (p less than 0.001). Positive blood cultures were significantly associated with surgical management (p = 0.007; OR = 3.42). In a sensitivity analysis restricted to infants with Bell Stage II/III NEC, base excess was significantly lower in surgically managed infants (p = 0.013). Lower platelet counts were significantly associated with mortality (p = 0.019). An exploratory multivariable mortality model incorporating lactate, platelet count, and the type of NEC management demonstrated an area under the curve of 0.737. Conclusions: Higher lactate levels, positive blood cultures, and pneumoperitoneum were associated with surgical management of NEC, while lower platelet counts were associated with mortality. Lower base excess was also associated with surgical management among infants with Bell Stage II/III disease. These routinely available clinical parameters may help identify infants with NEC who follow a more severe disease trajectory and could contribute to earlier risk stratification. Prospective multi-centre studies are required to determine their temporal and predictive value and validate their incorporation into clinical risk models.