Risk factors for mortality in preterm infants with necrotizing enterocolitis: a retrospective multicenter analysis

Abstract

It is difficult to predict the risk of mortality in necrotizing enterocolitis (NEC). This study aimed at identifying risk factors for severe NEC (Bell stage III) and mortality in preterm children with NEC. In this multicenter retrospective study, we analyzed multiple data from 157 premature children with confirmed NEC in the period from January 2007 to October 2018. We performed univariate, multivariate, stepwise logistic regression, and receiver operator characteristics (ROC) analyses. We were able to demonstrate that low Apgar scores (notably at 1′ and 5′), low hemoglobin concentration (Hgb), and high lactate level at disease onset and during disease correlated with NEC severity and mortality (P < 0.05, respectively). Severe NEC was related to congenital heart disease (CHD — OR 2.6, CI95% 1.2–5.8, P 0.015) and patent ductus arteriosus (PDA — OR 3.3, CI95% 1.6–6.9, P 0.0012), whereas death was related to the presence of PDA (OR 5.5, CI95% 2.3–14, P < 0.001).Conclusion: Low Apgar scores, low Hgb, high lactate levels, and the presence of CHD or PDA correlated with severe NEC or mortality in children with NEC. What is Known:• It remains difficult to predict which infant that suffers from necrotizing enterocolitis at risk of death.• Several clinical and laboratory parameters tools to predict fatal outcome in NEC. What is New:• The following laboratory parameters were associated with the risk of death from NEC: Hemoglobin concentration, base excess and lactate level.• The following clinical variables were associated with the risk of death from NEC: Apgar scores, as well as the presence of congenital heart disease and patent ductus arteriosus.

Necrotizing Enterocolitis: Incidence, Risk Factors, and Associated Morbidities in a Large Cohort of Infants with Very Low Birth Weight

“…NEC was an important risk factor for neonatal death, with a corresponding mortality rate twice as high as that observed among newborns without NEC. Similar findings were observed in a German study, in which the mortality rate of patients with NEC was 19%, while the mortality rate for those without was 6.2% [20].…”

Development of a Prediction Model for Surgery or Early Mortality at the Time of Initial Assessment for Necrotizing Enterocolitis

“…The strengths of the study include compliance with published guidelines on developing and reporting a multivariable prediction model, 38,42,43 The HASOFA score combines the established nSOFA score with additional variables that are important in other scales, have limited interobserver variability and may appear much earlier in the course of an acute abdomen. 12,13,[16][17][18][19][20][21][23][24][25][29][30][31] The prediction model using the HASOFA core was accurate even among the subset of infants with low acuity (clinically more stable) at initial assessment, in whom surgery for NEC stage III or death within a week would not otherwise have been predicted. In addition, accuracy of diagnosis of NEC and NEC stage was assured by extensive review of the EHR including surgical records, pathology, autopsy, and arbitration of questionable radiologic findings by a single blinded radiologist.…”

The Contribution of Low Apgar Scores in Identifying Neonates with Short-term Morbidities in a Large Single Center Cohort

“…The Apgar score is used as often for research into morbidities that manifest in the post-natal period, including all the discharge diagnoses used as shortterm outcomes in this current study. 10,[27][28][29][30][31][32][33][34][35] Short term outcomes have also been used for all studies that have examined modi cations or replacements for the Apgar, and any future such efforts are likely to do the same. [36][37][38] It is noteworthy that the NRP does not use the one-or ve-minute Apgar score.…”