title: Cluster of late preterm and term neonates with necrotizing enterocolitis symptomatology: descriptive and case-control study.
abstract: OBJECTIVE
  To investigate a necrotizing enterocolitis (NEC) cluster of late preterm and term neonates (gestational age ≥34 weeks).
  
  
  METHODS
  We conducted a descriptive and a case-control study. Medical records of neonates with modified Bell stage ≥ IB NEC and matched controls were reviewed, in addition to microbiological and environmental investigation. Study variables included maternal/delivery and neonatal factors, medications, procedures and feeding practices. Univariable/multivariable logistic regression analyses were performed for all and for stage ≥ II cases.
  
  
  RESULTS
  Out of 1841 late preterm and term neonates, 10 stage IB and 10 stage ≥ II [mean(SD) birthweight 2529.3 (493.04) g, gestational age 36.96 (1.48) weeks] presented with NEC symptomatology at mean 4.6 (range 2-8) days. Nearly all (19/20) resulted from high-risk pregnancies and received postpartum intermediate care. All were exclusively or partly formula fed. Most (14/20) were born by cesarean delivery. Eight underwent surgery, with no fatality. Intermediate care (p = 0.006), transient tachypnea (p = 0.049), not receiving breast milk (p = 0.019) and in addition intrauterine growth restriction (IUGR) (p = 0.017) for stage ≥ II cases were independently associated with NEC.
  
  
  CONCLUSIONS
  Late preterm and term neonates in need of intermediate care, with IUGR and transient tachypnea were susceptible to NEC; feeding with breast milk was an important protective factor.
authors.affiliation: a Department of Neonatology , Aretaieion Hospital, University of Athens Medical School , Athens , Greece .
authors.forename: Emmanouela
authors.initials: E
authors.lastname: Sdona
authors.affiliation: b Department of Child Health , National School of Public Health , Athens , Greece , and.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Papamichail
authors.affiliation: b Department of Child Health , National School of Public Health , Athens , Greece , and.
authors.forename: Takis
authors.initials: T
authors.lastname: Panagiotopoulos
authors.affiliation: c Department of Hygiene , Epidemiology and Medical Statistics, University of Athens Medical School , Athens , Greece.
authors.forename: Pagona
authors.initials: P
authors.lastname: Lagiou
authors.affiliation: a Department of Neonatology , Aretaieion Hospital, University of Athens Medical School , Athens , Greece .
authors.forename: Ariadne
authors.initials: A
authors.lastname: Malamitsi-Puchner
mesh_terms: D016022:Case-Control Studies; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology*; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D047929:Term Birth
keywords: Breast milk; NEC; late preterm; risk factors; term infant