Rotavirus-associated necrotizing enterocolitis: an insight into a potentially preventable disease?

Area of Science:

• Neonatalogy
• Pediatric Gastroenterology
• Infectious Diseases

Background:

• Necrotizing enterocolitis (NEC) is a serious gastrointestinal condition in neonates.
• The role of rotavirus infection (RVI) in NEC pathogenesis is not fully understood.
• Differentiating rotavirus-associated NEC (NEC + RV) from NEC without rotavirus (NEC-RV) is important for understanding disease severity and management.

Purpose of the Study:

• To test the hypothesis that NEC + RV differs from NEC-RV.
• To compare demographic, clinical, and outcome data between NEC + RV and NEC-RV infants.
• To identify factors influencing surgical intervention in NEC.

Main Methods:

• Prospective collection of data from neonates with modified Bell stage II or higher NEC.
• Confirmation of rotavirus infection (RVI) using immunoelectron microscopy (IEM) on fecal specimens.
• Comparison of disease severity, recurrence, pneumatosis distribution, surgical intervention, complications, and mortality between NEC + RV and NEC-RV groups.

Main Results:

• Of 2,444 NICU admissions, 129 (5.3%) had NEC; 38 (29%) were rotavirus positive.
• NEC + RV showed higher recurrence rates (P <.0001) and left-sided pneumatosis distribution (P <.0001).
• NEC-RV had a higher incidence of stage III or higher NEC (P =.032) and right-sided pneumatosis distribution (P <.0001).

Conclusions:

• NEC + RV is generally less severe than NEC-RV based on modified Bell staging.
• Severe pneumatosis, severe thrombocytopenia, and decreased human milk feedings were associated with increased odds for surgery.
• Monitoring RVI, infection control, human milk feedings, and enhancing neonatal immunity may reduce NEC + RV incidence.