Clinical predictors of necrotizing enterocolitis in premature infants.
BACKGROUND
Necrotizing enterocolitis (NEC) has emerged as the most common neonatal gastrointestinal emergency, is the most common cause of death in neonates undergoing surgery, and accounts for yearly additional hospital charges in excess of $6.5 million. Prematurity is the only common variable identified in case-controlled studies exploring this disease.


OBJECTIVE
To improve the understanding of the relationship between factors related to intestinal inflammation and ischemia and the enteral feeding regimen in the context of the premature gut, thereby identifying antecedents of NEC.


METHODS
Data were collected from the medical records of 247 premature infants for this retrospective case-controlled study. Diagnosis of NEC, as defined by Bell Stages IIA-IIIB, was required for study group assignment (n = 84). Multivariate analysis techniques were used to predict the relationships between selected variables on the outcome of NEC.


RESULTS
Premature infants were 13 times more likely to develop NEC if the infant required increased respiratory support to maintain oxygenation during the early neonatal period and 6.4 times more likely to develop NEC if the infant did not receive nutritionally fortified enteral feedings of breast milk. When both factors were present, the odds of NEC increased 28.6 times when compared with infants without these factors.


CONCLUSIONS
The study findings extend knowledge of antecedents to NEC beyond prematurity, highlighting the role that respiratory support and nutritional fortification of enteral feedings play in the pathogenesis of this disease. Early identification of antecedents to NEC will improve critical care management of the neonate and, in turn, decrease the incidence of this devastating gastrointestinal disease. The study findings will guide further inquiry in neonatal nutrition, physiologic and metabolic functioning, and acute clinical management of the neonate.
Gregory
Katherine E
KE
W. F. Connell School of Nursing, Boston College, Boston, Massachusetts 02467, USA. katherine.gregory.2@bc.edu
D016022:Case-Control Studies; D003422:Critical Care; D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000209:etiology*; D008895:Milk, Human; D015999:Multivariate Analysis; D010106:Oxygenators; D012189:Retrospective Studies