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Necrotizing enterocolitis: a prospective multicenter investigation
Insights
Necrotizing enterocolitis (NEC) in infants is linked to several pre- and post-natal factors. Identifying and modifying these risk factors may reduce NEC incidence and mortality rates.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Perinatal Epidemiology
Background:
- Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease affecting premature infants.
- Understanding risk factors is crucial for preventing NEC and improving infant survival rates.
Purpose of the Study:
- To prospectively identify pre- and post-natal factors associated with NEC development.
- To determine factors predicting mortality in infants diagnosed with NEC.
Main Methods:
- Prospective study of 11 NEC cases and 111 matched controls.
- Multivariate discriminant analysis to identify significant determinants.
Main Results:
- Ten independent determinants of NEC were identified, including Apgar score deterioration and patent ductus arteriosus.
- Ten factors predicted fatal outcomes in NEC cases, such as red blood cell transfusions and abdominal distension.
- Premature rupture of membranes was a determinant for NEC and a morbid event in cases.
Conclusions:
- Several modifiable pre- and post-natal factors contribute to NEC development and mortality.
- Intervention targeting identified risk factors may decrease NEC incidence and fatality.
Abstract:
Several pre- and post-natal factors possibly important in determining which infants will develop necrotizing enterocolitis (NEC) and which of these infants will die with this disease were prospectively studied in 1976 in 11 infants with radiographic or pathologic evidence of the disease from 12 institutions in the United States and 111 weight-matched, institution-matched control infants. By multivariant discriminant analysis, the authors idenfitied 10 independent significant determinants of NEC and 10 determinants predictive of a fatal outcome among case infants. Determinants of NEC were: Apgar score deterioration; presence of a patent ductus arteriosus; maternal receipt of anesthesia during delivery; infant not treated with parenteral gentamicin before the onset of disease; infant receipt of 10% dextrose solution; treatment of mother with antibiotics during pregnancy; hyperalimentation or gavage feedings; premature rupture of membranes. Important morbid events among cases included red blood cell transfusions, gas in the portal system, premature rupture of membranes, abdominal distension, isolation of Klebsiella organisms from the blood, surgery, prolonged perinatal oxygen requirement, and lower Apgar 2 score. Attempts to modify preventable risk factors may decrease the incidence (2.4 cases per 1000 live births) and case fatality (41%) documented in this study.