Hyperglycemia 72 h before necrotizing enterocolitis onset and mortality among premature and term infants in Kenya

Necrotizing enterocolitis (NEC) is a common complication among preterm infants but can also occur in term babies. A potential relationship between the onset of NEC and hyperglycemia has been suggested, but some studies report no association, necessitating further research to clarify the link between the two conditions. This study aimed to determine the proportion of NEC cases with hyperglycemia 72 h before its onset in preterm and term infants, identify clinical factors associated with hyperglycemia in these infants, and investigate the relationship between hyperglycemia and in-hospital mortality.

A retrospective cohort study was conducted at the Aga Khan University Hospital in Nairobi, Kenya. The participants included preterm and term infants treated for NEC at the hospital between January 1, 2014, and December 31, 2024. Patient data were retrieved from the electronic health records and paper files. Random blood sugar records 72 h before the diagnosis of NEC were assessed. Hyperglycemia was diagnosed based on a minimum of two blood glucose measurements exceeding 8.3 mmol/l (150 mg/dl). The study outcomes were proportion of NEC cases with hyperglycemia 72 h before its onset and in-hospital mortality. A generalized linear regression model with binomial probability distribution was used to identify the factors associated with hyperglycemia incidence in neonates diagnosed with NEC.

The proportion of NEC cases with hyperglycemia 72 h before its onset in preterm and term infants was 46.3%. Among the participants, 20.9% (n = 14) died before discharge, with no significant difference between those with (n = 8, 25.8%) and without (n = 6, 16.7%) hyperglycemia (p = 0.36). On multivariate analysis, the use of synchronized intermittent mandatory ventilation/non-invasive ventilation versus oxygen/room air was associated with an increased risk of hyperglycemia diagnosis. NEC requiring surgical intervention showed a more than three-fold risk of mortality compared with NEC treated with medical/supportive care only.

The results show that nearly half (46.3%) of the preterm and term infants with NEC were diagnosed with hyperglycemia 72 h before its onset. The diagnosis of hyperglycemia was not associated with in-hospital mortality. These findings should be validated in larger, adequately powered studies before clinical application.