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. Data were extracted from the selected papers included incidence of NEC cases and size of population at risk, author and publication details, follow up period covered by the study, location and setting of the study and whether it was VLBW infants or preterm infants. 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. In the presence of substantial heterogeneity, Random Effect Models (REM) were used as an additionally sensitivity analyses. 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: 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.

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.…”

Probiotics for Prevention of Necrotizing Enterocolitis

“…N ecrotizing enterocolitis (NEC) is a devastating disease affecting approximately 7% to 10% of infants born less than 1500 g (very low birth weight), with those born weighing less than 1000 g being at highest risk. 1 Infants diagnosed with NEC have an overall mortality rate close to 25%, with survivors being at an increased risk for both short-and long-term complications including short bowel syndrome, intestinal strictures, late-onset sepsis, cholestasis, and developmental delays. 2,3 Thus, there is a significant need for preventive strategies aimed at reducing the risk of NEC among vulnerable preterm infants in the neonatal intensive care unit (NICU).…”

Epidemiology of necrotizing enterocolities and its predictors among preterm newborns in Ethiopia: a systematic review protocol

“…It is most common in premature infants, but can also occur in full-term infants [1,2]. Globally, it affects about 7% of premature infants [3] with a mortality rate of 30-50% [4]. However, the incidence of NEC varies substantially across different parts of the world, likely due to differences in clinical and health settings.…”

“…However, the incidence of NEC varies substantially across different parts of the world, likely due to differences in clinical and health settings. Larger and higher-quality studies on the incidence of NEC and associated factors, especially in low-and middle-income countries, are warranted [3]. Despite advances in neonatal care, there is still debate about the best way to treat NEC [4].…”