Necrotizing Enterocolitis Among Neonates in the United States

Abstract

BACKGROUND:Prior studies have identified individual risk factors that are associated with necrotizing enterocolitis (NEC); however, the small sample sizes of these previous studies have not allowed the analysis of potential interaction between multiple variables and NEC. Our purpose was to describe the incidence and risk factors for NEC in premature neonates admitted for intensive care. METHODS:We identified neonates as having NEC if they met accepted diagnostic criterion for necrotizing enterocolitis. Using a national database, we assessed the association between NEC and a battery of risk factors previously reported in peer-reviewed literature. RESULTS:There were 15,072 neonates that met inclusion criteria; 14,682 did not have NEC, while 390 (2.6%) met criterion for NEC. Multivariate analysis showed that low birth weight was the most important risk factor for NEC. Other factors that were associated with an increased risk of NEC were exposure to antenatal glucocorticoids, vaginal delivery, need for mechanical ventilator support, exposure to both glucocorticoids and indomethacin during the first week of life, absence of an umbilical arterial catheter, and low Apgar score at 5 minutes. Length of hospital stay and mortality were higher in neonates with NEC than in neonates without NEC. CONCLUSIONS:NEC remains an important cause of morbidity and mortality in prematurely born neonates. In contrast to previous studies, we found that exposure to antenatal glucocorticoids was associated with an increased risk for NEC independent of birth weight.

Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants

“…Necrotizing enterocolitis (NEC) occurs in 3 to 10% of very low birth weight (VLBW) infants [1][2][3][4][5] and is associated with increased mortality and morbidity, including growth and neurodevelopmental impairment. [6][7][8][9][10][11] The pathophysiology of NEC is thought to involve immaturity of the immune, circulatory, and digestive systems; 6 hypoxic-ischemic injury, enteral feeding, and pathologic bacterial colonization.…”

Necrotizing enterocolitis during the first week of life: a multicentered case–control and cohort comparison study

“…[2][3][4] Other differences are apparent between patients who develop early NEC vs classical NEC. For instance, Guthrie et al 16 examined patients with classical NEC vs controls who did not develop NEC, and found them to be more likely to be delivered vaginally, with lower 5-min Apgar scores, and with lower birth weights. In contrast, in our present series of early NEC, compared with controls, the mode of delivery, 5-min Apgar score, and birth weights were similar.…”

A simple presurgical necrotizing enterocolitis-mortality scoring system

“…1,2 In the early stages of the disease, the clinical presentation is often rather nonspecific. Diagnostic tests and therapeutic management are thus often based on the experience of the physician involved, and there is great variation in the clinical, radiological and laboratory evaluation.…”