Necrotizing Enterocolitis: Finding Infants at Highest Risk

Abstract

Despite decades of research, necrotizing enterocolitis (NEC) remains one of the conditions within our neonatal intensive care units with the highest mortality. Experience has garnered the common realization that preterm infants and those requiring surgical therapy will fare the worst. However, clear clinical predictors to identify positively which infants will progress with the disease remain elusive.In this edition of The Journal of Perinatology, Moss and other investigators from six children's hospital across the United States present their data from their prospective, observational study. Although a negative study in which no new model could be developed to predict NEC, the analysis is an important contribution to further expand our knowledge of the risk factors for NEC progression. Dr Moss and colleagues characterized 455 infants with NEC into 'nonprogressors' who reached full feeding without surgical therapy or 'progressors' who either required surgical therapy or died from disease. Dedicated research nurses from the network collected data from a wide array of maternal, antenatal, intrapartum and newborn histories. Extensive daily feeding data including the mode and specific type of formula and/or total parenteral nutrition combination were also collected. Infants were followed during their inpatient hospitalization and extensive clinical data were collected relating to medications, radiology findings, ventilatory requirements, fluid and blood culture status. If infants received surgical therapy, surgical findings and postoperative data were also included in the analysis. The authors identified independent risk factors for progression of disease, with a particular focus on clinical information available at the time of diagnosis. Univariate analysis revealed NEC and progression to be associated with factors such as early gestational age, decreased birthweight, maternal age, intubation, compressions and portal venous gas, among others. Multivariate analysis identified 12 risk factors with 3 not previously described: teenaged mother, never have received enteral feeds before diagnosis and receipt of cardiac compressions/resuscitative drugs at delivery. Previously described risk factors were confirmed including factors such as Gramnegative bacteremia, portal venous gas, pneumatosis, metabolic acidosis at diagnosis, bandemia and low birth weight.One of the most interesting findings of this paper is the progression of NEC in infants who had never received enteral feeds. One plausible explanation for this finding might be that infants with NEC were being diagnosed early in life and thus may have