Increased incidence of necrotizing enterocolitis in the Netherlands after implementation of the new Dutch guideline for active treatment in extremely preterm infants: Results from three academic referral centers

Heida, Fardou H.; Stolwijk, Lisanne J.; Loos, Marie Louise H.J.; Ende, Stannie J. van den; Onland, Wes; Dungen, Frank A. M. van den; Kooi, Elisabeth M. W.; Bos, Arend F.; Hulscher, Jan B F; Bakx, Roel

doi:10.1016/j.jpedsurg.2016.11.024

Cited by 41 publications

(30 citation statements)

References 12 publications

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“…NEC incidence in this cohort was 6.8%. Although this reflects incidence rates described in larger international cohorts [14], it is considerably lower than that of a previous study in the Netherlands [1]. This apparent discrepancy may at least partly be explained by the limited follow-up period of 28 days.…”

Section: Discussioncontrasting

confidence: 72%

“…A new guideline on perinatal treatment of infants born extremely preterm was implemented in the Netherlands in 2010, lowering the border of viability to support active treatment from 25 to 24 weeks' gestation. This resulted in an increase in NEC incidences (16% in infants born at a gestational age [GA] < 28 weeks) and associated mortality [1].…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

et al. 2018

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Background: The identification of independent clinical risk factors for necrotizing enterocolitis (NEC) may contribute to early selection of infants at risk, allowing for the development of targeted strategies aimed at the prevention of NEC. Objective: The objective of this study was to identify independent risk factors contributing to the development of NEC in a large multicenter cohort. Methods: This prospective cohort study was performed in 9 neonatal intensive care units. Infants born at a gestational age ≤30 weeks were included. Demographic and clinical data were collected daily until day 28 postnatally. Factors predictive of the development of NEC were identified using univariate and multivariable analyses in a 1: 5 matched case-control cohort. Results: In total, 843 infants (56 NEC cases) were included in this study. In the case-control cohort, univariate analysis identified sepsis prior to the onset of NEC and formula feeding to be associated with an increased risk of developing NEC, whereas the administration of antibiotics directly postpartum was inversely associated with NEC. In a multivariable logistic regression model, enteral feeding type and the number of days parenterally fed remained statistically significantly associated with NEC, whereas the administration of antibiotics directly after birth was associated with a lower risk of developing NEC. Conclusions: Formula feeding and prolonged (duration of) parenteral feeding were associated with an increased risk of NEC. Contrary to expectations, the initiation of treatment with antibiotics within 24 h after birth was inversely associated with NEC.

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Section: Discussioncontrasting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

et al. 2018

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“…Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal emergencies in newborn infants and is defined by ischaemic necrosis of the intestine with a high mortality rate . Epidemiologic studies have identified multiple risk factors for the development of NEC, such as prematurity and low birthweight . NEC in late prematurity is rare, but could develop as a complication among otherwise predisposed infants .…”

Section: Introductionmentioning

confidence: 99%

Necrotizing enterocolitis in haemolytic disease of the newborn: a retrospective cohort study

et al. 2019

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Background and objectives Necrotizing enterocolitis (NEC) is a common and often severe gastrointestinal emergency in newborn infants. While usually affecting (very) premature infants, an association between NEC and haemolytic disease of the foetus and newborn (HDFN) has been suggested. HDFN may be an additional risk factor to develop NEC. The objective of this study was to evaluate the occurrence of NEC in infants affected with moderate to severe HDFN in a large single centre cohort as compared to a broad population of infants without HDFN. Materials and methods Retrospective cohort study of medical records of neonates with and without HDFN, with a gestational age at birth ≥30 weeks and ≤38 weeks, and admitted to the Leiden University Medical Center between January 2000 and December 2016. Results A total of 3284 patient records of infants born in the study period were reviewed and 317 cases of HDFN were identified. The incidence of NEC was significantly higher among infants with HDFN compared to infants without HDFN: 4/317 affected infants (1·3%) vs. 11/2967 affected infants (0·4%, relative risk 3·40, 95% confidence interval: 1·09–10·63). Conclusions We observed a higher incidence of NEC in an overall late preterm to near term population of infants with moderate to severe HDFN, compared to infants born without HDFN. The clinician taking care of an HDFN‐affected infant should be cautious of this higher risk.

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“…99,199,200 Heida found decreasing frequencies of surgical interventions from 53% in 2005-2007 to 29% in 2011-2013, with pneumoperitoneum increasing its share of indications for surgery from 47 to 63%. 201 ❖ Indications for Surgery The only generally accepted indication for surgery is PP on AR, 70,202,203 as a sign of intestinal perforation. Especially in the extremely low birth weight infants, however, the sensitivity of radiographic signs is low, 26,39 PP is known to be missing in a great proportion of infants with perforated NEC.…”

Section: Treatmentmentioning

confidence: 99%

“…In populations not restricted to a particular range of gestational age or birth weight, mortality rates of 12 to 38,5% have been reported 25,28,84,85,140,201,207,208 with seemingly lower rates in later publication years. After surgical treatment, mortality may be considerably higher.…”

Section: Outcomementioning

confidence: 99%

Necrotising Enterocolitis - epidemiology and imaging

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Increased incidence of necrotizing enterocolitis in the Netherlands after implementation of the new Dutch guideline for active treatment in extremely preterm infants: Results from three academic referral centers

Cited by 41 publications

References 12 publications

Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

Necrotizing enterocolitis in haemolytic disease of the newborn: a retrospective cohort study

Necrotising Enterocolitis - epidemiology and imaging

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