[Enteropathy in premature newborn infants. Prospective study over one year]

In neonatal units, there is a tendency to assume that any acutely sick infant with gastro-intestinal symptoms has necrotizing enterocolitis (NEC). This prospective study was conducted to find a better definition of enteropathy in preterm neonates and their risk factors.

All the 351 preterm neonates admitted to a neonatal unit from 1 August 1988 to 31 July 1989 were included in the study. A chart including 45 items was established for each infant, with special attention to data on the pregnancy, delivery, any early ischemic and/or infectious problem, nutrition and any gastro-intestinal (GI) problem. All the neonates were fed similarly, depending their maturation, gestational age and GI status. Each infant was assigned to one of 5 categories: 1) no GI problem; 2) transient obstruction; 3) NEC with pneumatosis; 4) hemorrhagic colitis without obstruction or pneumatosis; 5) other GI disease.

267 infants had no GI problem during their stay in the neonatal unit. 53 developed GI symptoms: 23 transient obstructions, 6 NEC, and 24 hemorrhagic colitis. The mean age at onset of symptoms in these last 3 categories was 7 days, 14 days and 23 days, respectively. Ten risk factors were found to be significantly correlated with GI disturbances: umbilical venous catheter, benzodiazepines, birth weight < 1,500 g, patent ductus arteriosus, ventilatory assistance, abnormal amniotic fluid, gestational age < 32 weeks, early antibiotic treatment, passage of meconium > 48 hours, episodes of apnoea and/or bradycardia.

This follow-up shows that the GI disturbances of preterm neonates admitted to a neonatal unit, specially those having one or more risk factors, can be separated into 3 groups: 1) isolated intestinal obstruction, seen in the most immature babies during the first week of life with the risk of developing NEC; 2) frank blood in the stool, indicating colitis and possibly minor forms of NEC; 3) combined obstructive and hemorrhagic symptoms, typical of NEC.