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Increased risk of illness among nursery staff caring for neonates with necrotizing enterocolitis
Insights
An outbreak of necrotizing enterocolitis (NEC) in 1983 suggested a transmissible agent. Nurses caring for ill infants had a higher risk of illness, supporting infection control measures during NEC outbreaks.
Area of Science:
- Neonatal Medicine
- Infectious Disease Epidemiology
- Public Health
Background:
- An outbreak of necrotizing enterocolitis (NEC) and hemorrhagic gastroenteritis occurred in newborn nurseries in 1983.
- Eleven infants were affected, with three requiring bowel resections.
- Illness among medical and nursing staff prompted an investigation.
Purpose of the Study:
- To investigate the cause of the NEC outbreak.
- To determine if a transmissible agent was responsible.
- To evaluate the utility of epidemiologic methods in NEC research.
Main Methods:
- Comprehensive microbiologic and viral testing of infant stool samples.
- Assays for Clostridium difficile toxin and viral antigens.
- Epidemiologic investigation using relative risk calculation (incidence density ratio).
Main Results:
- No specific pathogen was identified through laboratory testing.
- Nurses caring for ill infants showed a statistically significant higher risk (relative risk, 1.96; P = 0.05) of sick call within 9 days.
- This suggests a potential transmissible agent linked to NEC.
Conclusions:
- The findings provide evidence for a transmissible agent in some NEC cases.
- Recommends implementing infection control measures during NEC outbreaks.
- Highlights the value of epidemiologic methods for future NEC studies.
Abstract:
In 1983 an outbreak of necrotizing enterocolitis (NEC) and hemorrhagic gastroenteritis occurred in our newborn nurseries. Eleven children were ill and three required bowel resections. During the outbreak many of the medical and nursing staff in the nurseries also were ill, prompting a microbiologic and epidemiologic investigation. Bacterial and viral cultures, Clostridium difficile toxin assays, enzyme-linked immunosorbent assays for viral antigens and immunoelectron microscopy of stools identified no associated pathogen. However, using a method of calculating relative risk as an incidence density ratio, we found that nurses who had cared for ill infants were at higher risk for sick call within the 9 days following exposure than nurses who had cared for babies without NEC (relative risk, 1.96; P = 0.05). These results provide additional evidence that a transmissible agent may be responsible for some cases of NEC and support the recommendation for infection control measures during outbreaks. The epidemiologic methods used in this study may be useful in prospective studies of NEC and may help to provide further clues to the cause of this disease.