Global Incidence of Necrotizing Enterocolitis: a Systematic Review and Incidence Meta-Analysis

Abstract

Background: Necrotizing Enterocolitis (NEC) is a major source of morbidity and mortality in the Neonatal Intensive Care Unit (NICU), yet the global incidence is not systematically evaluated. We conducted a systematic review and Meta-Analysis of cohort studies reporting the incidence of NEC in infants with Very Low Birth Weight (VLBW).Methods: The databases searched included PubMed, MEDLINE, the Cochrane Library, EMBASE and grey literature. Eligible studies were cohort or population-based studies of newborns including registry data reporting incidence of NEC. Data were extracted from the selected papers and variables extracted included author and publication details, time period covered by the study, location and setting of the study and whether it was VLBW infants or preterm infants, incidence or number on NEC cases and size of population at risk were extracted from the selected papers. Additionally, risk of bias assessment of the included studies were carried out using a validated tool. Bias adjusted Quality Effect Model (QEM) were used to pool the estimates. Due to substantial heterogeneity, Random Effect Model (REM) estimates were also evaluated. The heterogeneity between studies were evaluated using the Cochrane Q statistics and Higgin’s I2 value. Subgroup analysis and meta-regression were used to explore the sources of heterogeneity. Funnel plots as appropriate for ratio measures were used to assess publication bias.Results: A systematic and comprehensive search of databases identified 27 cohort studies reporting the incidence of NEC. The pooled estimate of the global incidence of NEC was 6.0% (95% CI: 4.0%-9.0%). There were substantial heterogeneity (I2 = 100%) between studies. Funnel plots showed no evidence of publication bias.Conclusion: The incidence of NEC vary considerably, although meta-regression failed provide evidence for any substantial regional variation. High quality studies along with detailed risk factors of NEC is warranted, to predict and NEC.

Necrotizing Enterocolitis in a Dutch Cohort of Very Preterm Infants: Prevalence, Mortality, and Long-Term Outcomes

“…Globally, the incidence of NEC among very premature infants is reported to be around 7%, and NEC-related death rates vary between 20 and 50%, [13][14][15][16] which figures correspond well to our findings. Despite advancement of neonatal care over the years and decreased overall neonatal mortality in the Netherlands, 17 the mortality rate for NEC remained unchanged between 2008 and 2020 in our center.…”

The Validity of Positive Coagulase-Negative Staphylococcus Cultures for the Diagnosis of Sepsis in the Neonatal Unit

“…Both, term and premature infants hospitalized in neonatal intensive care units (NICU), are at increased risk of acquiring an invasive infection, however, the rate of infection is inversely proportional to gestational age and birth weight (3) (4). Additionally, congenital malformations, inadequate nutritional state and invasive procedures, increase the probability of developing sepsis (4), (5), (6), (7).…”

Differential Expression Profiles and Functional Prediction of circRNAs in Necrotizing Enterocolitis

“…Although significant advances have been made in neonatal care in recent decades, NEC is associated with high morbidity and mortality rates [1]. A previous systematic review reported that approximately 7% of infants born with deficient birth weight admitted to NICU have NEC [2]. In addition, surviving infants exhibit digestive tract and neurological sequelae [3].…”