Necrotizing Enterocolitis in Preterm Neonates: Prognostic Factors and Outcome: Necrotizing Enterocolitis in Preterm Neonates

Roohiya  Marium; Shaista  Ehsan; Saba Haider  Tarar; Amal  Farrukh; Nadia  Shahid; Mehreen  Ahsan

doi:10.54393/pjhs.v4i03.634

Authors

Roohiya Marium Department of Pediatrics, Ziauddin Medical University, Karachi, Pakistan
Shaista Ehsan Department of Pediatrics, Ziauddin Medical University, Karachi, Pakistan
Saba Haider Tarar Department of Pediatrics, Shaheed Mohtarma Benazir Bhutto Medical College, Mirpur, Pakistan
Amal Farrukh Department of Medicine, Aga Khan University, Karachi, Pakistan
Nadia Shahid Department of Surgery, Ziauddin Medical University, Karachi, Pakistan
Mehreen Ahsan Department of Gynecology and Obstetrics, Ziauddin Medical University, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v4i03.634

Keywords:

Premature, Necrotizing Enterocolitis, Modified Bell’s Criteria, Mortality, Sepsis, Enteral Feed

Abstract

Necrotizing Enterocolitis (NEC) contributes significantly to a high neonatal death rate in Pakistan and other developing countries. A number of elements related to its development are modifiable and can be addressed. Objectives: To evaluate the frequency of NEC, its associated factors and outcome in preterm babies. Methods: This retrospective, cross-sectional study was conducted at Ziauddin University Hospital, Karachi. Medical records of admitted preterm newborns from 1^st December 2020 till 1^st December 2022 were reviewed and neonates meeting the modified Bell’s diagnostic criteria ,with NEC stage II and III were included. Data pertaining to antenatal period, delivery and postnatal course of the disease were recorded . Data analysis were done using SPSS version-20 and results expressed as frequencies and percentages. Chi square test was applied with p-value statistical significance set at <0.05. Results: The prevalence of NEC was observed to be 7.1%. Male to female ratio was 1.6:1 with 84.5% of the neonates being low birth weight and culture-proven sepsis present in 44.8%. The mortality rate was 32.7%. Thrombocytopenia, hypotension, formula feeds, a positive blood culture and invasive ventilation were significant risk factors for mortality (p-value 0.01) Conclusions: Necrotizing enterocolitis has a high prevalence and mortality in preemies. Sepsis, formula feeding and a low birth weight adversely affect outcome. Early diagnosis and timely intervention can improve survival

References

Neu J and Walker WA. Necrotizing enterocolitis. New England Journal of Medicine. 2011 Jan; 364(3): 255–64. doi: 10.1056/NEJMra1005408.

Thyoka M, De Coppi P, Eaton S, Khoo K, Hall NJ, Curry J, et al. Advanced necrotizing enterocolitis part 1: mortality. European Journal of Pediatric Surgery. 2012 Feb; 22(1):8-12. doi: 10.1055/s-0032-1306263.

Huda S, Chaudhery S, Ibrahim H, Pramanik A. Neonatal necrotizing enterocolitis: Clinical challenges, pathophysiology and management. Pathophysiology .2014 Feb; 21 (1): 3-12. doi: 10.1016/ j.pathophys.2013.11.009.

Bora R and Murthy NB. In resource limited areas complete enteral feed in stable very low birth weight infants (1000-1500 g) started within 24 h of life can improve nutritional outcome. The Journal of Maternal-fetal and Neonatal Medicine. 2017Nov; 30(21): 2572–7. doi:10.1080/14767058.2016.1256992.

Berkhout DJC, Klaassen P, Niemarkt HJ, de Boode WP, Cossey V, van Goudoever J B et al. Risk factors for necrotizing enterocolitis: a prospective multicenter case-control study. Neonatology. 2018 Jul; 114(3): 277-84. doi: 10.1159/000489677.

Sharma R, Khajuria K, Chauhan M. Prevalence and outcome of necrotizing enterocolitis in very low birth weight babies in a tertiary care hospital. International Journal of Scientific Research. 2017 Jun; 6(6): 52-3.

Alsaied A, Islam N, Thalib L. Global incidence of necrotizing enterocolitis: a systematic review and meta-analysis. BMC Pediatrics. 2020 Jul; 20:344. doi: 10.1186/s12887-020-02231-5.

Shah SSH and Mahmood T. Very low birth weight babies with Necrotizing enterocolitis—Incidence and outcome. Journal of University Medical and Dental College. 2016 Mar; 7(4): 13-8.

Shah SS, Saleem M, Mehmood T, Ahmed T. Frequency and outcome of necrotizing enterocolitis in preterm neonates. Journal of Ayub Medical College Abbottabad. 2015 Jan-Mar; 27(1): 85-7.

Temere BC, Mewahegn AA, Zewudie BT, GebreEyesus FA, Kassaw A, Walle BG et al. Necrotizing Enterocolitis and Its Predictors Among Preterm Neonates Admitted in Neonatal Intensive Care Units of Gurage Zone Public Hospitals, Southwest Ethiopia, 2021. Pediatric Health Medicine and Therapeutics. 2022 Mar; 13:95-102. doi: 10.2147/PHMT.S353663.

Patel RM, Ferguson J, McElroy SJ, Khashu M, Caplan MS. Defining necrotizing enterocolitis: current difficulties and future opportunities. Pediatrics Research. 2020 Aug; 88(Suppl 1): 10-5. doi: 10.1038/ s41390-020-1074-4.

Mekonnen SM, Bekele DM, Fenta FA, Wake AD. 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. Global Pediatric Health. 2021 May; 8: 2333794X211019695. doi: 10.1177/2333794X211019695.

Rees CM, Eaton S, Pierro A. National prospective surveillance study of necrotizing enterocolitis in neonatal intensive care units. Journal of Pediatric Surgery. 2010 Jul; 45(7): 1391-7.

Satardien M, Van Wyk L, Sidler D, Van Zyl JI. Outcomes of Neonates Requiring Neonatal Intensive Care Admission for Necrotizing Enterocolitis in a Resource-Restricted Hospital in Cape Town, South Africa. Journal of Tropical Pediatrics .2021 Jan; 67(1): fmaa130. doi: 10.1093/tropej/fmaa130.

Mufti P and Bhutta ZA. Necrotizing enterocolitis in infants weighing less than 2000 G. Journal of Pakistan Medical Association. 1992 Feb; 42(2): 37-9.

Dong Y, Speer CP, Glaser K. Beyond sepsis: Staphylococcus epidermidis is an underestimated but significant contributor to neonatal morbidity. Virulence. 2018 Jan; 9(1): 621-633.

Gane B, Bhat BV, Adhisivam B, Joy R, Prasadkumar P, Femitha P, et al. Risk factors and outcome in neonatal necrotizing enterocolitis. Indian Journal of Pediatrics. 2014 May; 81(5): 425-8.

Siahaan ESED, Adriansyah W, Sasmita AP, Fauzi AR, Dwihantoro A, Gunadi. Outcomes and Prognostic Factors for Survival of Neonates with Necrotizing Enterocolitis. Frontiers in Pediatrics. 2021 Oct; 9: 744504. doi:10.3389/fped.2021.744504.

Bracho-Blanchet E, Torrecilla-Navarrete ME, Zalles-Vidal C, Ibarra-Ríos D, Fernández-Portilla E, Dávila-Pérez R. Prognostic factors related to mortality in newborns with necrotising enterocolitis. Cirugía y Cirujanos. 2015 Feb; 83(4): 286–91. 10.1016/j.circen.2015.09.015.

Han SM, Hong CR, Knell J, Edwards EM, Morrow KA, Soll RF, et al. Trends in incidence and outcomes of necrotizing enterocolitis over the last 12 years: a multicenter cohort analysis. Journal of Pediatric Surgery. 2020 Jun; 55(6): 998–1001. doi: 10.1016/j.jpedsurg.2020.02.046.

Hull MA, Fisher JG, Gutierrez IM, Jones BA, Kang KH, Kenny M, et al. Mortality and management of surgical necrotizing enterocolitis in very low birth weight neonates: a prospective cohort study. Journal of American College of Surgeons. 2014 Jun; 218(6): 1148–55.

Hong CR, Han SM, Jaksic T. Surgical considerations for neonates with necrotizing enterocolitis. Seminars in Fetal and Neonatal Medicine. 2018 Dec; 23: 420–5. doi: 10.1016/j.siny.2018.08.007.

Kastenberg ZJ and Sylvester KG. The surgical management of necrotizing enterocolitis. Clinics in Perinatology. 2013 Mar; 40(1): 135–48.