Which is a risk factor of necrotizing enterocolitis in the preterm infant

Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Rinawati Rohsiswatmo Department of Child Health, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta
  • Ahmad Kautsar Department of Child Health, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta
  • Audesia Alvianita Sutrisno Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Central Java
  • Hardya Gustada Hikmahrachim Faculty of Medicine, Universitas Indonesia, Jakarta
  • Nieta Hardiyanti Medical School, Universitas Tarumanegara, Jakarta
  • DOI: //doi.org/10.14238/pi62.3.2022.186-91

    Keywords: necrotizing enterocolitis; preterm; gastrointestinal tract; survival rate; risk factor

    Abstract

    Background Necrotizing enterocolitis (NEC) is a prematurity-related complication of the gastrointestinal tract that affects 3-15% of preterm infants. Due to its atypical signs and symptoms, NEC is often diagnosed late, leading to mortality and morbidity.

    Objective To describe the incidence, characteristics, and survival rate of preterm infants with NEC in the Neonatal Unit of Cipto Mangunkusumo Hospital.

    Methods This prospective cohort study was conducted on preterm infants born in Cipto Mangunkusumo Hospital in 2019 who had NEC Bell stage 2 or higher. Subjects were recruited consecutively. NEC was classified into either early-onset (<14 days of life) or late-onset (?14 days of life). We identified the risk factors of mortality and survival using multiple Cox regression.

    Results Within the study period, 55/639 preterm infants born in Cipto Mangunkusumo Hospital were diagnosed with NEC. Mean gestational age was 31.16 (SD 2.63) weeks and mean birth weight was 1,378.12 (SD 438.26) grams. The median age at NEC diagnosis was 6 (range 0-24) days. The most common symptoms were gastrointestinal bleeding (29.09%) and abdominal distension (29.09%). Plain abdominal radiographs showed dilated bowels in 92.72%, thickened intestinal walls in 83.63%, and pneumatosis intestinalis in 61.81% of subjects. Positive blood cultures were found in 63.63% of subjects, with Staphylococcus epidermidis and Klebsiella pneumoniae being the predominant organisms. Median survival was 27 days and 31 days for infants born at <32 weeks and ?32 weeks gestational age, respectively (P=0.37). Median survival was 27 and 28 days in infants with early-onset and late-onset NEC, respectively (P=0.07), and 23 and 28 days in infants with birth weight of <1,000 grams and ?1,000 grams, respectively (P=0.14).

    Conclusion The incidence of NEC among preterm infants born in Cipto Mangunkusumo Hospital in 2019 was 8.6%. The survival rate of infants with NEC was 27.27%. Early-onset and late-onset NEC had similar mortality rates.

    Author Biography

    Ahmad Kautsar, Department of Child Health, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta



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    Published

    2022-06-21

    How to Cite

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    Kaban R, Rohsiswatmo R, Kautsar A, Sutrisno A, Hikmahrachim H, Hardiyanti N. Risk factors of necrotizing enterocolitis-related mortality in preterm neonates: a preliminary prospective study. PI [Internet]. 21Jun.2022 [cited 21Dec.2022];62(3):186-1. Available from: //www.paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2912

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    Issue

    Vol 62 No 3 (2022): May 2022

    Section

    Neonatology

    Copyright (c) 2022 Risma Karina Kaban

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    Which is a risk factor of NEC in the preterm infant?

    NEC affects 5 to 10% of premature infants born weighing less than 1500 g. Among the risk factors defined for NEC, prematurity and birth weight remain inversely related to risk for NEC. Term infants who develop NEC usually have specific risk factors such as congenital heart disease, sepsis, and low blood pressure.

    What is the possible risk factor of necrotizing enterocolitis during pregnancy?

    Commonly observed risk factors are prematurity, low birth-weight, enteral feeding, blood transfusion, and sepsis. Breast milk and probiotics have been demonstrated to be protective factors. 13, 14, 15, 16, 17 However, whether neonates with other risk factors might also have a chance of contacting NEC is not clear.

    What causes necrotizing enterocolitis in newborns?

    In premature infants, the cause may be related to the immaturity of the child's digestive system. NEC involves infection and inflammation in the child's gut, which may stem from the growth of dangerous bacteria or the growth of bacteria in parts of the intestine where they do not usually live.

    Which factors place the neonate at risk for necrotizing enterocolitis?

    Necrotizing Enterocolitis Risk Factors While there appears to be no single cause of necrotizing enterocolitis, risk factors include premature birth and early feedings in premature babies with an immature gut. Babies who have had difficult deliveries with lowered oxygen levels can also develop necrotizing enterocolitis.

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