The influence of physiologic factors and clinical interventions on the incidence of necrotizing enterocolitis in preterm infants

Necrotizing enterocolitis (NEC) is characterized by ischemic necrosis of the preterm bowel and has emerged as the most common neonatal gastrointestinal emergency in the world. Numerous physiologic factors are associated with NEC, however, only prematurity has been identified as a common variable in case-controlled studies exploring this disease.; This retrospective, predictive case-controlled study involved data collection from the medical records of 247 preterm infants born between 1997 and 2003 at Tufts-New England Medical Center in Boston, MA. Multivariate analysis techniques were used to answer two research questions predicting the relationships between selected variables on the outcomes of NEC and NEC requiring surgery.; Logistic regression correctly classified 62.7% of the preterm infants diagnosed with NEC (p=.000), accounting for 31% to 43% of the variance. Two of the variables, respiratory support (p=.000, B=2.633) and nutritional fortification of breast milk ( p=.033, B=1.497) were significant. The odds of the infant developing NEC were 14 times higher if the infant required increased respiratory support to maintain oxygenation during the early neonatal period and 4.5 times higher if the infant did not receive fortified breast milk. If the infant had both risk factors the odds of NEC increased 28.6 times.; Logistic regression correctly classified 56.7% of the preterm infants who required surgery as a result of developing NEC (p=.000), accounting for 31.1% to 42.6% of the variance. An increase in hemodynamic support necessary to maintain oxygenation and perfusion in the NICU was found to play a significant role in the analysis (p=.017, B=1.409). The odds of the infant requiring surgery for NEC were 3.19 times higher when the infant required an increase in hemodynamic support.; This study will inform clinicians of risk factors associated with NEC. The findings will yield further inquiry in neonatal nutrition, physiologic and metabolic functioning, and acute clinical management of the neonate.