Sepsis Associated Necrotizing Enterocolitis (SA-NEC) in Preterm Infants: Risk Factors and Clinical Outcomes

Necrotizing enterocolitis (NEC) is a major gastrointestinal emergency in preterm infants, often associated with sepsis that worsens the outcomes. Data from low- and middle-income settings are limited. This retrospective study described the clinical spectrum and short-term outcomes of NEC and compared sepsis-associated NEC (SA-NEC) with non-sepsis-associated NEC (non-SA NEC). Preterm infants with ≥ stage 2 NEC admitted between March 2022 and February 2025 were included. SA-NEC was defined as NEC with culture-proven sepsis at onset of illness. Of 55 infants with NEC (median gestational age 31 wk 1 d; birth weight 1,195 g), 54.5% had SA-NEC. Compared with non-SA NEC, SA-NEC had higher rates of acute kidney injury [OR 9.75; 95% CI 2.6-36.6, p < 0.001], perforation [OR 4.6; 1.3-16.6, p = 0.02] and mortality [OR 8.9; 2.52-31.4, p < 0.001]. SA-NEC represents a more severe clinical phenotype with significantly poorer outcomes. Strengthening infection control practices and adopting comprehensive NEC prevention strategies are crucial to improving outcomes in preterm infants.