Cluster of late preterm and term neonates with necrotizing enterocolitis symptomatology: descriptive and case–control study

Abstract

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/multivariable logistic regression analyses were performed for all and for stage ≥ II cases.

Results: Out of 1841 late preterm and term neonates, 10 stage IB and 10 stage ≥ II [mean(SD) birthweight 2529.3 (493.04) g, 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 were exclusively or partly formula fed. Most (14/20) were born by cesarean delivery. Eight underwent surgery, with no fatality. Intermediate care (p = 0.006), transient tachypnea (p = 0.049), not receiving breast milk (p = 0.019) and in addition intrauterine growth restriction (IUGR) (p = 0.017) for stage ≥ II cases were independently associated with NEC.

Conclusions: Late preterm and term neonates in need of intermediate care, with IUGR and transient tachypnea were susceptible to NEC; feeding with breast milk was an important protective factor.

• Breast milk
• late preterm
• NEC
• risk factors
• term infant

Acknowledgements

The authors would like to thank Assoc. Profs. S. Baka, G. Petropoulos and lecturer M. Bouroutzoglou for their help in data collection. The authors acknowledge the substantial guidance and advice on statistical analysis by the late Prof. D. Trichopoulos, who passed away before the submission of this article.

Declaration of interest

The authors report no conflicts of interest.