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Risk factors of necrotizing enterocolitis in very low birth weight infants: a meta-analysis
1The Second Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
Insights
Necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants is linked to small gestational age, red blood cell transfusions, maternal hypertensive disorders, PDA, and sepsis. These factors increase NEC risk in VLBW infants, guiding prevention strategies.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Epidemiology
Background:
- Necrotizing enterocolitis (NEC) is a critical gastrointestinal emergency in premature infants.
- Very low birth weight (VLBW) infants are particularly susceptible to NEC.
- Identifying primary risk factors is crucial for effective prevention and management.
Purpose of the Study:
- To conduct a meta-analysis identifying primary risk factors for NEC in VLBW infants.
- To provide robust scientific evidence for clinical prevention and treatment strategies.
- To consolidate and confirm existing associations between clinical factors and NEC risk.
Main Methods:
- Systematic literature search across PubMed, Embase, Cochrane Library, and Web of Science databases.
- Inclusion of case-control, cohort, and cross-sectional studies published up to October 10, 2025.
- Quality assessment using NOS and AHRQ scores, with data pooled via a random-effects model in Stata 15.
Main Results:
- Meta-analysis of 16 studies involving 179,289 patients.
- Significant risk factors identified: Small Gestational Age (OR=1.35), red blood cell transfusion (OR=1.75), maternal hypertensive disorders (OR=1.27), patent ductus arteriosus (OR=1.56), and sepsis (OR=1.87).
- All identified factors demonstrated a statistically significant association with increased NEC risk in VLBW infants.
Conclusions:
- This meta-analysis confirms key risk factors associated with NEC in VLBW infants.
- Small gestational age, red blood cell transfusion, maternal hypertensive disorders, patent ductus arteriosus, and sepsis are confirmed as significant contributors to NEC risk.
- Findings support targeted interventions and enhanced surveillance for VLBW infants with these risk factors.
Background:
This study aims to explore the primary risk factors for necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants through meta-analysis, providing scientific evidence for clinical prevention and treatment.
Methods:
A systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science databases for studies investigating risk factors for NEC in VLBW infants, covering the period from database inception to October 10, 2025. Eligible studies included case-control studies, cohort studies, and cross-sectional studies meeting the inclusion criteria. Quality assessment was performed using the NOS and AHRQ scores. Data were pooled using Stata 15 software with a random-effects model.
Results:
a total of 16 research articles involving 179,289 patients included, meta-analysis results suggest that Small Gestational Age [OR = 1.35, 95% CI (1.14, 1.60)], red blood cells transfusion [OR = 1.75, 95% CI (1.26, 2.43)], maternal hypertensive disorders [OR = 1.27, 95% CI (1.03, 1.57)], patent ductus arteriosus [OR = 1.56, 95% CI (1.30, 1.88)], sepsis [OR = 1.87, 95% CI (1.22, 2.87)] were associated with NEC in very low birth weight infants.
Conclusion:
This systematic meta-analysis consolidates and confirms previously reported associations between several clinical factors and the risk of necrotizing enterocolitis in very low birth weight infants. The findings support the association of small gestational age, red blood cell transfusion, maternal hypertensive disorders, patent ductus arteriosus, and sepsis with an increased risk of NEC.
Systematic Review Registration:
PROSPERO CRD420251149565.
