Necrotizing enterocolitis in term neonates: data from a multihospital health-care system

Abstract

Objective: In the past 5½ years, 30 term or near-term neonates in the Intermountain Healthcare system developed necrotizing enterocolitis (NEC) Bell's stage XII. We sought to identify possible explanations for why these patients developed NEC, by comparing them with 5847 others that did not develop NEC, from the same hospitals and of the same gestational ages, cared for during the same 5½-year period.Study design: Data were collected from neonates admitted to any of the Intermountain Healthcare NICUs with a birth date from 1 January 2001 to 30 June 2006, and a gestational age >36 weeks. A variety of patient features and feeding practices were compared between those that did vs did not develop NEC.Result: Forty-one neonates >36 weeks gestation were listed in the discharge records as having NEC of Bell's stage II or higher. However, on review of these 41 medical records, 11 were seen to have had NEC of Bell's stage I, whereas the remaining 30 had radiographs and clinical courses indicative of Bell's stage XII. Those 30 formed the basis of this study. Twenty-eight of the 30 developed NEC after having been admitted to an NICU for some other reason; the other two developed NEC at home, within 2 days of being discharged from an NICU. The 30 that developed NEC were more likely than the 5847 that did not develop NEC, to have congenital heart disease (P ¼ 0.000), polycythemia (P ¼ 0.002), earlyonset bacterial sepsis (P ¼ 0.004) or hypotension (P ¼ 0.017). All 30 received enteral feedings before NEC developed; 29 were fed either artificial formula or a mixture of formula and breast milk. The one that was exclusively fed human milk was fed human milk with added fortifier (24 cal/oz). The 30 that developed NEC were more likely to be fed formula exclusively (P ¼ 0.000). Seven of the 30 had a laparotomy for NEC; two of the seven had total bowel necrosis and support was withdrawn. The other five had perforations and bowel resections. The mortality rate was 13% (4/30). Conclusion:In our series, NEC among term or near-term neonates was exclusively a complication developing among patients already admitted to a NICU for some other reason. We speculate that the combination of reduced mesenteric perfusion and feeding with artificial formula were factors predisposing them to develop NEC.

Necrotizing enterocolitis during the first week of life: a multicentered case–control and cohort comparison study

“…9 The 30 cases in that report, and the 21 cases in the present report, have several items in common. Actually, 2 of the cases of NEC in term neonates are included among the present 21 with early NEC, and therefore the total of the two reports is 49 distinct cases.…”

“…One example of a very transient precondition might be the effects of illicit maternal drug use. A maternal illicit drug history was not observed as a common feature among term infants with NEC, 9 but was significant among those who developed early NEC.…”

“…These 2 cases were previously published among 30 cases of NEC in term infants. 9 Total 20 of the 21 with confirmed NEC had been admitted to a neonatal intensive care unit (NICU) for treatment of another condition. The other patient, a small-for-gestational-age (SGA) infant with a tight nuchal cord at delivery, developed NEC while in a well baby nursery.…”

The little database that could: Intermountain Health Care and the uphill quest for prevention of term necrotizing enterocolitis

“…Now there could be many reasons why donor milk did not prove to be efficacious, including the fact that it is pasteurized, but there is little doubt that mother's breast milk is the ideal solution for NEC prevention. This brings us back to the database that Bob Christensen has expertly engineered and the conclusions of DK Lambert et al 1 regarding term NEC. The biggest nugget in the manuscript, in this editorialist's opinion, is the capacity to identify prospectively term infants at risk for NEC.…”

“…The cohort study by Lambert et al 1 in this edition of The Journal of Perinatology will stand the test of time as being one of those smart studies with a small cohort of interest (just 30 affected patients), that gave the field of neonatology some important answers. First of all, they asked a specific and targeted question.…”