Epidemiological trends in infant mortality related to necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is the leading cause of gastrointestinal morbidity and mortality among infants in the neonatal intensive care unit. With an overall prevalence of 1%, NEC is found in about 11% of infants with very low birthweights (VLBW) and 22% in infants of extremely low birthweights. A disease of prematurity, NEC has a multifactorial pathogenesis involving a combination of feeding regimens, gut microbiome, and birth weight. This study aims to elucidate the demographic factors associated with NEC- mediated infant mortality, with the goal of guiding future research into disease diagnosis and management.

The CDC WONDER database was queried to collect data on mortality from NEC of infants <1 year old between 1999 and 2023. Data was stratified by sex, race/ethnicity, urbanization status, and census region. Crude mortality rate (CMR) was determined, and Joinpoint analysis was conducted to identify significant changes in mortality trends.

Overall NEC-related CMR decreased slightly between 1999 and 2023. CMR was higher in males than females throughout the study period, though mortality decreased slightly in the male population. When stratified by race, Non-Hispanic (NH) Black or African American patients had the highest overall CMR, followed by Hispanic or Latino and NH White patients, respectively. Regionally, the South had the highest CMR across the four studied census regions, though Southern mortality decreased over the study period. The West reported the lowest mortality from NEC and was the only census region with reported increase in CMR. In both urban and rural areas, mortality initially increased before a subsequent decrease throughout the study period.

This study builds on prior research efforts into mortality trends in NEC to highlight the disproportionate mortality burden associated with NEC faced by certain groups, including males, NH Black of African American patients, and patients from the Southern United States. Further research into the implications of different socioeconomic determinants of health and biomarker variability by demographic cohort can guide more effective diagnostic and management strategies.