Risk factors for the development of necrotizing enterocolitis: A case-control study

Abstract

AIM: To determine risk or protective factors for the development of necrotizing enterocolitis in very low birth weight infants. METHODS: This retrospective case-control study was conducted at La Paz University Hospital including infants with a birth weight of <1500 g for three years. Cases with confirmed diagnosis of necrotizing enterocolitis were evaluated; each one was paired with a control infant of the same gestational age. Statistical analysis included unadjusted and multivariable analyses. RESULTS: A total of 576 very low birth weight infants were admitted; of them 30 infants (5.2%) developed necrotizing enterocolitis. The main clinical and demographic characteristics did not differ between the two groups. The frequency of infants transfused with packed red blood cells was similar in cases (63%) and control patients (77%). However, a greater number of transfusions increased the odds of necrotizing enterocolitis [OR 1.5, 95%CI (1.01 to 2.24)]. CONCLUSIONS: A greater number of transfusions of packed red blood cells are associated with an increased risk of necrotizing enterocolitis in very low birth weight infants. The other analyzed variables in this study do not identify the infants at risk. Caution is advocated in using transfusions in newborns.

Associations between Red Blood Cell Transfusions and Necrotizing Enterocolitis in Very Low Birth Weight Infants: Ten-Year Data of a Tertiary Neonatal Unit

“…When considering possible risk factors, we did not find an association between NEC and gestational age, birth weight, sex, Apgar scores at one and five minutes of life, RDS (plus surfactant) or PDA (plus ibuprofen), which was consistent with the similar study of Martin et al [22]. On the other hand, in a study, which had a sample three times bigger than ours (111 cases and 222 controls) PDA and treatment with indomethacin were found to differ significantly between cases and controls [21].…”

“…We found that all three variables describing transfusion before NEC correlated with NEC compared very similarly to some previous studies. Transfusion as a nominal variable had an adjusted odds ratio (OR) of 3.0 (95% CI 1.1, 8.0, p = 0.034), which is almost identical to that reported by Wan-Huen et al [19] For transfusion as an ordinal variable, the unadjusted OR was 1.5 (95% CI 1.0, 2.2, p = 0.04), which is the same as in Martin et al [22] and the adjusted OR (1.6, 95% CI 1.0, 2,5, p = 0.056), although of borderline statistical significance, is comparable to the report of Bak et al [20] Moreover, in our study the volume of PRBC transfused also significantly correlated with increased odds of NEC (adjusted OR 1.04, 95% CI 1.0, 1.1, p = 0.043).…”

“…On the other hand, in a study, which had a sample three times bigger than ours (111 cases and 222 controls) PDA and treatment with indomethacin were found to differ significantly between cases and controls [21]. Moreover, assuming that NEC can be caused by ischemic events early in life [1], low Apgar scores were found to be contributing to the NEC cases in Bak et al, but the number of cases in that study was only 18 and the control group was not matched to the case group [20]; furthermore, bigger studies did not confirm this fact [19,21,22].…”

“…A strong correlation between NEC and congenital infection has been found in this work: Significantly more infants in the NEC group had a congenital infection (79.6% vs. 59.3%, p = 0.022) and its calculated odds-ratio for NEC was 2.7 (95% 1.1, 6.3, p = 0.024). We could not find any studies in which a variable of congenital infection was analyzed, however, other infection characteristics, such as sepsis [19], chorioamnionitis [21], or nosocomial sepsis [22], were previously found to be of no significance between NEC and control groups. Thus, it is possible that the diagnosis of congenital infection could be another unique predictor of NEC in VLBW infants, especially considering the fact that antibiotic therapy did not modify the occurrence of NEC in our study (92.6% of infants in both groups received antibiotics before NEC, p = 1.000).…”

Necrotizing enterocolitis: clinical characteristics and outcome of a cohort of 106 cases at a children’s hospital in North China

“…However, some studies suggest transfusion may be an aggravating factor. [25][26][27] But this may be because of the presence of anemia and not the transfusion aggravating the NEC. 28 Pre-terms frequently require transfusion to improve oxygen delivery to the vital organs during the crucial phase of growth and development, but there are still controversies regarding optimal management of anemia in pre-term neonates.…”