[Feeding patterns and risk factors in an epidemic of neonatal necrotizing enterocolitis.]

To study the relationship between neonatal feeding patterns and the emergence of neonatal necrotizing enterocolitis during the epidemic of this disease in Iceland in 1987-1990.

This was a retrospective case-controlled study of 18 newborns that developed neonatal necrotizing enterocolitis during a four year epidemic of the disease. Two newborns of similar weight and gestational age served as controls for each case. The amount of food given per kilogram of body weigth was recorded every 12 hours for each group and plotted against time. The differences in amount of food for the individuals of each group were calculated, regression lines found and these compared by t-test. The type of food the children received was also noted and compared, as was the presence of several other possible risk factors.

The statistical calculation (t-test) showed that there was no significant difference between the patients and the controls as regards the amount of food given and the increase in the amount of each feeding (p=0.6). Sixteen (88.9%) of the patients had been fed before the occurrence of the disease. All had been fed through a gastric tube but only 20 (55.6%) of the controls, this is a significant difference (p=0.03). Three (18.8%) of the patients and 18 (50%) of the controls were given breast milk at their first feed. This difference however is not statistically significant (p=0.07). Comparison was also made of the occurrence of the following risk factors: umbilical catheter, perinatal asphyxia, polycythemia, acute or semiacute cesarian section, respiratory distress and being small for gestational age. Only births by cesarian section showed a significant difference between the groups (p= 0.004). Comparison of the number of risk factors did not show a statistically significant difference (p= 0.05). However there was a linear trend towards the patients having more risk factors than the controls (p=0.01).

The study did not show that the epidemic of neonatal necrotizing enterocolitis in Iceland in 1987-1990 was caused by the increments in feeding given prior to the development of the disease. Two possible risk factors, feeding by gastric tube and birth by acute or semiacute cesarian section, were significantly more often found in the patient group than in the control group.