[Pathogenic factors and therapeutic criteria in 82 newborn infants with necrotizing enterocolitis]

Sixty newborn infants with necrotizing enterocolitis (NEC) were retrospectively studied in 1979. The incidence was 0,49/1.000 living newborns: 81% were under 2,500 g and 30% under 1.500 g. We found a very low incidence of the so-called pathogenic factors. Feeding started in this group on the 24 h of life, with adapted formulas; 28% underwent surgery with a postoperative mortality of 62% and an overall mortality of 28%. Ten out of the 17 deceased were under 1.500 g. From 1979 with a similar medical treatment we introduced a prospective study consisting of a protocol of 10 different parameters including clinical, radiological and analytical values, the aim being a more objective way of indicating when to operate the patient. Special meticulous care of the nutrition of the low-weight babies was taken; 22 patients were treated til 1982, only 4,5% were under 1.500 g. The initial feeding time in all high risk babies under 1.250 g being 7 days with gastric gavage and elementary diets. All the infants with more than 60% values in the protocol underwent surgery (38%). The postoperative mortality was 37% with an overall mortality of 19%. A look back to our series suggests a clear usefulness of the protocol and the suspicion that the delay on feeding with intragastric continuous perfusion in low weight babies reduces NEC.