The Prevalence of Necrotizing Enterocolitis and Associated Factors Among Enteral Fed Preterm and Low Birth Weight Neonates Admitted in Selected Public Hospitals in Addis Ababa, Ethiopia: A Cross-sectional Study

Abstract

Necrotizing enterocolitis (NEC) remains to be the most critical and frequent gastrointestinal disorder understood in neonatal intensive care units (NICU). The presented study was intended to assess the prevalence of NEC and associated factors among enteral Fed preterm and low birth weight neonates. Institution based retrospective cross-sectional study was conducted on 350 enteral Fed preterm and low birth weight neonates who were admitted at selected public hospitals of Addis Ababa from March 25/2020 to May 10/2020. The data were collected through neonates’ medical record chart review. A total of 350 participants were enrolled in to the study with the response rate of 99.43%. One hundred eighty-four (52.6%) of them were male. The majority 123 (35.1%) of them were (32 + 1 to 34) weeks gestational age. The prevalence of NEC was (25.4%) (n = 89, [95% CI; 21.1, 30.0]). Being ≤28 weeks gestational age (AOR = 3.94, 95% CI [2.67, 9.97]), being (28 + 1 to 32 weeks) gestational age (AOR = 3.65, 95% CI [2.21, 8.31]), birth weight of 1000 to 1499 g (AOR = 2.29, 95% CI [1.22, 4.33]), APGAR score ≤3 (AOR = 2.34, 95% CI [1.32, 4.16]), prolonged labor (AOR = 2.21, 95% CI [1.35, 6.38]), maternal chronic disease particularly hypertension (AOR = 3.2, 95% CI [1.70, 5.90]), chorioamnionitis (AOR = 4.8, 95% CI [3.9, 13]), failure to breath/resuscitated (AOR = 2.1, 95% CI [1.7, 4.4]), CPAP ventilation (AOR = 3.7, 95% CI [1.50, 12.70]), mixed milk (AOR = 3.58, 95% CI [2.16, 9.32]) were factors significantly associated with NEC. Finally, the prevalence of NEC in the study area was high. So that, initiating the programs that could minimize this problem is required to avoid the substantial morbidity and mortality associated with NEC.

Necrotizing Enterocolitis and Its Predictors Among Preterm Neonates Admitted in Neonatal Intensive Care Units of Gurage Zone Public Hospitals, Southwest Ethiopia, 2021

“…But, the finding was lower than studies conducted in Addis Ababa, Ethiopia (25.4%). 5 This difference might be due to the differences in population segment, as the study in Addis Ababa includes low birth weight infants as an inclusion criterion.…”

“…The sample size was determined using a single population proportion using the proportion of NEC 25.4%. 5 Assuming the Z α/2=critical value for normal distribution at 95% confidence level, 5% margin of error (W). After adding a 5% non-response rate, the final sample size was 288.…”

“… 4 In one study, the prevalence of NEC among enteral Feed preterm and low birth weight neonates was 25.4%. 5 The burden of NEC in 820 US centers was (7.6%). 6 Early neonatal death was strongly associated with prematurity and NEC in different settings, including Ethiopia.…”

Importance of Combinations of Risk Factors in the Development of Necrotizing Enterocolitis in Newborn Children

“…Our results are consistent with those of various authors who have studied the risk factors for NEC and found that low birth weight is the most frequently mentioned significant risk factor for NEC in newborns in the modern literature, which is consistent with studies describing the highest incidence of NEC among infants with the lowest body weight at birth. These authors also show that severe RDS was a significant risk factor for the development of NEC [2]. Mechanical ventilation, newborn weight, and maternal age have also been associated with an increased risk of NEC [2,7,8].…”

“…The most complex and least studied problem in neonatology is necrotizing enterocolitis (NEC). The vast majority of children with NEC are premature babies with a body weight less than 1500 g. According to various authors, NEC occurs at a frequency of 2-10 per 1000 premature babies with very low and extremely low birth weight [1,2]. Surgical stages of NEC occur on average in 50% of sick children, mortality in this case reaches 20%, and with extensive intestinal necrosis it can reach 80-100%.…”