Global incidence of Necrotizing Enterocolitis: a systematic review and Meta-analysis

Abstract

Background: Necrotizing Enterocolitis (NEC) is a major cause of morbidity and mortality in the Neonatal Intensive Care Unit (NICU), yet the global incidence of NEC has not been 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. Incidence were pooled using Random Effect Models (REM), in the presence of substantial heterogeneity. Additional, bias adjusted Quality Effect Models (QEM) were used to get sensitivity estimates. 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 number of neonate included in these studies was 574,692. Of this 39,965 developed NEC. There were substantial heterogeneity between studies (I 2 = 100%). The pooled estimate of NEC based on REM was 7.0% (95% CI: 6.0-8.0%). QEM based estimate (6.0%; 95% CI: 4.0-9.0%) were also similar. Funnel plots showed no evidence of publication bias. Although, NEC estimates are similar across various regions, some variation between high and low income countries were noted. Meta regression findings showed a statistically significant increase of NEC over time, quantified by the publication year. Conclusion: Seven out of 100 of all VLBW infants in NICU are likely to develop NEC. However, there were considerable heterogeneity between studies. High quality studies assessing incidence of NEC along with associated risk factors are warranted.

Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Network Meta-Analysis

“…Necrotizing enterocolitis (NEC) is a significant cause of morbidity and mortality in preterm infants with low birth weight (BW) and gestational age (GA). Recent meta-analyses estimated that 7% of low BW infants in neonatal intensive care units are likely to develop NEC [ 1 ]; mortality varies from 10% to 30% and has remained largely unchanged since the initial disease description several decades ago.…”

Enteral Feeding Interventions in the Prevention of Necrotizing Enterocolitis: A Systematic Review of Experimental and Clinical Studies

“…Around 5 to 10% of very low birth weight (VLBW) infants develop NEC, with the highest incidence among neonates with an extremely low birth weight (ELBW) [2]. Despite advancing medical care, NEC incidence has not substantially decreased over time, mainly due to increased early survival of neonates [3][4][5]. NEC mortality is inversely correlated with birth weight and generally ranges from 15% to 30% [2,6].…”

Cardiac and Inflammatory Necrotizing Enterocolitis in Newborns Are Not the Same Entity

“…Despite improvement of neonatal care and the development of novel treatment options, the morbidity and mortality rates of NEC remain high (1). However, due to overall improvements in neonatal care, such as the introduction of donated breast milk, the incidence rate of NEC has been increasing steadily in parallel with rising survival rates of premature infants -the patient population at greatest risk for developing NEC (2)(3)(4). One problem contributing to the high mortality rate of NEC patients is the difficulty of diagnosing and treating the condition in a timely manner.…”