Arch Pediatr, an open access journal ISSN: 2575-825X 1 Volume 2018; Issue 02 Archives of Pediatrics Research Article Hirpara DH, et al. Arch Pediatr: JPED-146. Predictors of Development and Diagnostic Delay of Post-Necrotizing Enterocolitis Strictures Dhruvin H. Hirpara 1 , Arash Azin 1 , Chethan Sathya 1 , Hau D Le 2 , Aideen M. Moore 3 , Annie H. Fecteau 4* 1 Department of Surgery, University of Toronto, Toronto, Ontario, Canada 2 Division of Pediatric Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA 3 Division of Neonatology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada 4 Division of General and Thoracic Surgery, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada * Corresponding author: Annie Fecteau, Division of General and Thoracic Surgery, The Hospital for Sick Children (SickKids) 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. Tel: +14168136402; Fax: +14168137477; Email: annie.fecteau@sickkids.ca Citation: Hirpara DH, Azin A, Sathya C, Le HD, Moore AM, et al. (2018) Predictors of Development and Diagnostic Delay of Post- Necrotizing Enterocolitis Strictures. Arch Pediatr: JPED-146. DOI: 10.29011/2575-825X. 100046 Received Date: 15 February, 2018; Accepted Date: 21 February, 2018; Published Date: 02 March, 2018 DOI: 10.29011/2575-825X. 100046 Abstract Objectives: To evaluate predictors of post-Necrotizing Enterocolitis (NEC) stricture development and explore the incidence, location, and time to diagnosis of post-NEC strictures at a major pediatric teaching hospital. Methods: A retrospective review of infants from 2003-2013 was performed. Data collected included demographics, treatment type, NEC stage, time to presentation and diagnosis of strictures, and laboratory values (C-reactive protein, minimum platelet count, duration of thrombocytopenia, and pH). Univariate, Multivariate and Wilcoxon-Rank Sum testing was used to evaluate the association between variables and stricture development. Results: A total of 175 infants with NEC were identifed, of which 35 (20%) developed post-NEC strictures. Univariate analysis revealed that patients receiving laparotomy (p<0.01), with higher NEC stage (p=0.013), elevated CRP (<0.01), lower platelet counts (p=0.018), greater duration of thrombocytopenia (p=0.011) and lower blood pH (p=0.028) were at signifcant risk of stric- ture development. After multivariate analysis, however, only elevated CRP values were found to be predictive of stricture devel- opment (p<0.047). Additionally, patients with small bowel strictures took signifcantly longer (35 days) to present with symptoms of obstruction than those with strictures in the large bowel (18.5 days; p=0.037). There was a trend towards delay in diagnosis of small bowel strictures, however, this diference did not achieve statistical signifcance (p=0.09). Conclusions: A higher index of suspicion should be maintained for intestinal strictures in patients with advanced NEC and el- evated infammatory markers. Symptoms of obstruction may take longer to manifest in infants with small bowel strictures. Keywords: Antibiotics; Necrotizing Enterocolitis; Post-NEC Stricture; Surgery Introduction Necrotizing Enterocolitis (NEC), a common gastrointestinal complication in newborn infants, is characterized by variable damage to the intestinal tract, ranging from mucosal injury to full- thickness necrosis and perforation. NEC occurs in 1 to 3 per 1000 live births and 1 to 7.7 percent of admissions to neonatal intensive care units. Although early recognition and aggressive treatment of this disorder has improved clinical outcomes, NEC accounts for substantial long-term morbidity in survivors of neonatal intensive care, particularly in premature very low birth weight (BW) infants (<1500 g). The mortality rate (15%-25%) for afected infants has not changed appreciably in 30 years [1,2]. The optimal treatment of NEC, via medical intervention, peritoneal drainage, or laparotomy is also controversial. Many infants with NEC recover uneventfully with medical therapy and have long-term outcomes similar to unafected infants of matched gestational age. Infants with progressive disease requiring peritoneal drainage and/or surgical intervention sufer almost all of the mortality and morbidity. Of these, approximately 30%-40% will die of their disease and most