Necrotizing Enterocolitis in Very Low Birth Weight Neonates: A Natural History Study

Abstract

Objective – We characterize the most recent natural history of necrotizing enterocolitis (NEC), as this is an essential first step in guiding the prevention and treatment of this disease in the present day. Study Design – We performed a retrospective cohort study of neonates who were born at 23-29 weeks gestation and birth weight <1500 grams who received care from the Pediatrix Medical Group between 2004 and 2019. We assessed the incidence of medical and surgical NEC and the patterns of initial antibiotic treatment to develop a contemporary cohort for further analysis. Among patients discharged between 2015 and 2019 we characterized the stage-specific risk factors for patients diagnosed with medical or surgical NEC, as well as patterns of disease onset, progression, biomarkers and outcomes. We used the same approach to characterize patients diagnosed with suspected NEC. Results – Among 34032 patients in the contemporary cohort, 1150 (3.4%) were diagnosed with medical NEC and 543 (1.6%) were diagnosed with surgical NEC. The temporal pattern of disease onset was different for medical and surgical NEC, with gestational age- and birth weight-specific risk disparities emerging earlier in surgical NEC. Thirty-day mortality was much greater among surgical NEC patients (medical NEC 16.4% vs. surgical NEC 43.0%), as were rates of various in-hospital and long-term outcomes. Suspected NEC was diagnosed in 1256 (3.7%) patients, among whom risk factors and disease onset, progression, and outcomes closely resembled those of medical NEC. Conclusion – Analyzing data from a contemporary cohort enabled us to characterize the current, stage-specific natural history of NEC, including novel insights into suspected NEC. Future studies could leverage this cohort to characterize how specific patient characteristics, care processes or biomarkers may influence or predict disease outcomes.

A weighted and cumulative point system for accurate scoring of intestinal pathology in a piglet model of necrotizing enterocolitis

“…The immature immune and digestive systems render preterm infants vulnerable to NEC, with factors such as formula feeding and bacterial colonization playing pivotal roles [1, 2]. On average, 5-10% of preterm neonates develop NEC with higher incidences among infants born very preterm (< 28 weeks of gestation) or with a very low birth weight (VLBW, < 1500 g) [3, 4]. The severe and rapid progression of NEC makes the disease a particular challenge for clinicians in the neonatal intensive care unit.…”

Determining Knowledge and Opinions of Neonatal Intensive Care Unit Nurses on Wet-Nursing and Human Milk Banks: A Cross-Sectional Study in Türkiye

“…In such cases, the WHO (2022) recommends alternative feeding methods such as using donor milk, formula, or artificial feeding when breastfeeding is not possible or contraindicated. Human milk is particularly crucial for preterm infants, as it has been shown to reduce the risk of life-threatening complications such as late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) in NICU settings (Mara et al, 2022; Perrin et al, 2022). When breastfeeding is not feasible, wet-nursing and human milk banks (HMBs) serve as important sources of human milk for infants who cannot be breastfed due to reasons related to the mother or the infant (Ergin & Uzun, 2018; Jones & Tracy, 2022).…”

Elimination of the RETNLB Gene Alleviates Intestinal Damage in NEC Mice

“…It has been reported previously that the morbidity of NEC among those born < 1000g preterm infants is as high as 5-22%, with a mortality rate ranged from 21.9-38% for all NEC patients in twelve high-income countries [8]. A single-center retrospective cohort study of very low birth weight (VLBW) infants in the United States showed that the incidence of NEC in VLBW infants was 3.4% (1150/34,032), with a mortality rate 16.4% [9]. Therefore, pressing issues include how to better prevent the onset of NEC, lower the mortality rate, and improve the prognosis of neonates.…”