Risk factors for intestinal failure in infants with necrotizing enterocolitis: a Glaser Pediatric Research Network study.
OBJECTIVE
To determine risk factors for intestinal failure (IF) in infants undergoing surgery for necrotizing enterocolitis (NEC).


METHODS
Infants were enrolled in a multicenter prospective cohort study. IF was defined as the requirement for parenteral nutrition for >or= 90 days. Logistic regression was used to identify predictors of IF.


RESULTS
Among 473 patients enrolled, 129 had surgery and had adequate follow-up data, and of these patients, 54 (42%) developed IF. Of the 265 patients who did not require surgery, 6 (2%) developed IF (OR 31.1, 95% CI, 12.9 - 75.1, P < .001). Multivariate analysis identified the following risk factors for IF: use of parenteral antibiotics on the day of NEC diagnosis (OR = 16.61, P = .022); birth weight < 750 grams, (OR = 9.09, P < .001); requirement for mechanical ventilation on the day of NEC diagnosis (OR = 6.16, P = .009); exposure to enteral feeding before NEC diagnosis (OR=4.05, P = .048); and percentage of small bowel resected (OR = 1.85 per 10 percentage point greater resection, P = .031).


CONCLUSIONS
The incidence of IF among infants undergoing surgical treatment for NEC is high. Variables characteristic of severe NEC (low birth weight, antibiotic use, ventilator use, and greater extent of bowel resection) were associated with the development of IF.
Duro
Debora
D
Division of Gastroenterology and Nutrition, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA. dduro@med.miami.edu
Kalish
Leslie A
LA
Johnston
Patrick
P
Jaksic
Tom
T
McCarthy
Maggie
M
Martin
Cami
C
Dunn
James C Y
JC
Brandt
Mary
M
Nobuhara
Kerilyn K
KK
Sylvester
Karl G
KG
Moss
R Lawrence
RL
Duggan
Christopher
C
D001724:Birth Weight; D015331:Cohort Studies; D020345:Enterocolitis, Necrotizing / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010372:Pediatrics / Q000379:methods; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D012778:Short Bowel Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery
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