Summary:
Objective: To investigate a necrotizing enterocolitis (NEC) cluster of late
preterm and term neonates (gestational age 34 weeks).
Methods: We conducted a descriptive and a case-control study. Medical records
of neonates with modified Bell stage IB NEC and matched controls were
reviewed, in addition to microbiological and environmental investigation. Study
variables included maternal/delivery and neonatal factors, medications,
procedures and feeding practices. Univariable and multivariable logistic
regression analyses were performed for all and for stage II cases.
Results: Out of 1,841 late preterm and term neonates, 10 stage IB and 10 stage
II [mean(SD) birthweight 2529.3(493.04) grams, gestational age 36.96(1.48)
weeks] presented with NEC symptomatology at mean 4.6 (range 2-8) days. Nearly
all (19/20) resulted from high risk pregnancies and received postpartum
intermediate care. All cases were exclusively or partly formula fed. Most
(14/20) were born by caesarean delivery. Eight underwent surgery, with no
fatality. No microbiological cause was identified. Intermediate care (p=0.006),
transient tachypnea (p=0.049) and intrauterine growth restriction (p=0.017) for
stage II cases were independently associated with NEC, while breast milk
(p=0.019) was associated with lower likelihood for NEC.
Conclusions: Late preterm and term neonates in need of intermediate care, with
intrauterine growth restriction and transient tachypnea were susceptible to
NEC; feeding with breast milk was an important protective factor.
Keywords:
Necrotizing enterocolitis, Late preterm, Term infant, Risk factors, Breast milk
