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Risk factors for necrotizing enterocolitis in preterm infants: how race, gender, and health status contribute
Brigit M Carter1, Diane Holditch-Davis
1Chapel Hill School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA. bmcarter@email.unc.edu
Insights
Prolonged mechanical ventilation and hospital-acquired infections significantly increase the risk of necrotizing enterocolitis (NEC) in preterm infants. Black infants also show a higher incidence of NEC, highlighting key risk factors for this serious condition.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Clinical Epidemiology
Background:
- Necrotizing enterocolitis (NEC) is a severe gastrointestinal emergency in preterm infants.
- Identifying risk factors is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To investigate infant characteristics and health factors associated with NEC development in high-risk preterm infants.
- To identify key predictors of NEC in a vulnerable neonatal population.
Main Methods:
- Secondary analysis of data from 134 preterm infants at high risk for NEC.
- Utilized logistic regression, Fisher's exact tests, and correlation analyses.
- Examined mechanical ventilation duration, infections, birth weight, race, and gender as potential predictors.
Main Results:
- Increased duration of mechanical ventilation and a higher number of nosocomial infections were strongly associated with increased NEC risk.
- Black preterm infants exhibited a significantly higher incidence of NEC compared to other racial groups.
- Birth weight and infant gender were not significant predictors in logistic regression, though birth weight showed correlation due to its association with other factors.
Conclusions:
- Number of infections and duration of mechanical ventilation are primary predictors of NEC in preterm infants.
- Black preterm infants face a disproportionately higher NEC diagnosis rate.
- Understanding these empirical risk factors enables healthcare providers to refine care for high-risk neonates.
Purpose:
To examine 5 infant characteristics and health factors that might be risk factors for necrotizing enterocolitis (NEC) in preterm infants.
Subjects:
One hundred thirty-four preterm infants at high risk for NEC because of either having a birth weight of <1500 g or requiring mechanical ventilation at birth.
Design:
Descriptive secondary analysis using data from a larger longitudinal study.
Methods:
Weekly review of infants' medical record until discharge; demographic questionnaire completed by mothers at the time of enrollment; and data analysis done with logistic regression, Fischer's exact tests, and correlations.
Outcome Measures:
Total number of days the infant required mechanical ventilation, birth weight in grams, number of infections prior to NEC diagnosis, maternal race (black, white, or Asian), and infant gender were used to predict the development of NEC.
Results:
Maximum likelihood estimates indicated that mechanical ventilation had a positive relationship with developing NEC, such that as the number of days of mechanical ventilation increased so did the risk of developing NEC. There was also a very strong positive relationship between the number of nosocomial infections and NEC, indicating that as the number of infections increased, the likelihood of developing NEC increased. Although the relationship between race and NEC was not significant in the logistic regression, the Fisher exact test showed that black preterm infants had increased incidence of NEC as compared with other races. This relationship was not due to correlations between race and mechanical ventilation or infections. No relationship between gender and NEC was noted. Birth weight was not significantly associated with NEC in the logistic regression but was correlated with NEC, probably because of its correlation with mechanical ventilation and number of infections.
Conclusions:
In this sample, number of infections and length of mechanical ventilation were the primary predictors of NEC in preterm infants. In addition, the frequency that black infants are diagnosed with NEC is significantly higher than that of other races. Knowledge of risk factors for NEC can allow healthcare providers to evaluate and adjust care practices for preterm infants who present with higher risk for NEC on the basis of empirical data.
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