The antecedents and correlates of necrotizing enterocolitis and spontaneous intestinal perforation among infants born before the 28th week of gestation

Article type: Research Article

Authors: Singh, R.^{a; b; *} | Shah, B.^{a; b} | Allred, E.N.^{c; d} | Grzybowski, M.^e | Martin, C.R.^{d; f} | Leviton, A.^{c; d} | for the ELGAN Study co-investigators

Affiliations: [a] Department of Pediatrics, Baystate Children’s Hospital, Springfield, MA, USA | [b] Tufts University School of Medicine, Boston, MA, USA | [c] Department of Neurology, Boston Children’s Hospital, Boston, MA, USA | [d] Harvard Medical School, Boston, MA, USA | [e] Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA | [f] Department of Pediatrics, Beth Israel Deaconess Medical Center, Boston, MA, USA

Correspondence: [*] Address for correspondence: Rachana Singh, MD MS, Division of Newborn Medicine, Baystate Children’s Hospital, 759, Chestnut Street, Springfield, MA 01199, USA. Tel.: +1 413 794 2207; Fax: +1 419 794 5100; E-mail: [email protected].

Abstract: OBJECTIVE: To identify antecedents of “medical” necrotizing enterocolitis (mNEC), “surgical” NEC (sNEC), and spontaneous intestinal perforation (SIP) in newborns delivered before 28 weeks gestation. STUDY DESIGN: Prospective multicenter cohort study. During study period, 2002– 2004, women delivering before 28 weeks gestation at one of 14 participating institutions were enrolled. Well defined antenatal and postnatal variables were collected. Bivariate analyses were performed to identify candidates for developing multinomial multivariable time-oriented logistic regression models. RESULTS: Of the 1320 infants, 5% had mNEC, 6% had sNEC, and 4% had SIP. Antecedents of mNEC included mother’s identification as Black, consumption of aspirin during the pregnancy, and vaginal bleeding after the 12th week of gestation. For sNEC the antecedents were maternal self- support, obesity and anemia during the pregnancy, birth before the 24th week, birth weight ≤750gm, and receipt of fresh frozen plasma (FFP) during the first postnatal week. An infant was at increased risk of SIP if the placenta had increased syncytial knots, birth occurred before the 24th week, and received FFP during the first week. CONCLUSIONS: Maternal and neonatal characteristics might help identify at-risk ELGANs for NEC and SIP, who then may potentially benefit from targeted preventive strategies.

Keywords: Antenatal and perinatal correlates, necrotizing enterocolitis, spontaneous intestinal perforation

DOI: 10.3233/NPM-16915100

Journal: Journal of Neonatal-Perinatal Medicine, vol. 9, no. 2, pp. 159-170, 2016