Title : Early versus Late Onset Necrotizing Enterocolitis in Very Low Birth Infants in the Neonatal Intensive Care Unit
Background: Necrotizing Enterocolitis (NEC), one of the most severe emergencies in neonates, is a multifactorial disease with diverse risk factors.
Objectives: To compare between the clinical and laboratory characteristics of premature infants diagnosed with early-onset NEC (EO-NEC) and those with late-onset NEC (LO-NEC).
Patients and methods: Enrolled infants were identified from prospective local data collected for the Israel National very low birth weight (VLBW, <1500 grams) infant database and from the local electronic patient files data base for the period 1996-2017.
Results: Overall, 95 VLBW infants (61, 64.21% EO-NEC and 34, 35.87% LO-NEC) were enrolled. EO-NEC infants had higher rate of IVH grade 3 and 4 (26.2% vs 2.9%, p=0.005). LO-NEC infants had a higher incidence of previous bloodstream infections (35.3% vs 8.2%, p=0.002) compared with EO-NEC. EO-NEC infants were more likely to undergo surgery (49.2% vs 26.5%, p=0.031), less likely to receive postnatal steroids (8.2% vs 20.6%, p=0.109) and had a higher risk of death (59% vs 41%, p=0.095) than LO-NEC. In multivariable analysis models surgical intervention was associated with EO-NEC (OR: 4.627, p=0.013) as well as PDA and positive blood culture prior to the NEC episode (table 3).
Conclusions: Our data support the hypothesis that EO-NEC has significant different clinical and microbiological attributes compared with LO-NEC.