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Necrotizing Enterocolitis Among Neonates in the United States

Journal of Perinatology volume 23, pages 278–285 (2003)Cite this article

Abstract

BACKGROUND: Prior studies have identified individual risk factors that are associated with necrotizing enterocolitis (NEC); however, the small sample sizes of these previous studies have not allowed the analysis of potential interaction between multiple variables and NEC. Our purpose was to describe the incidence and risk factors for NEC in premature neonates admitted for intensive care.

METHODS: We identified neonates as having NEC if they met accepted diagnostic criterion for necrotizing enterocolitis. Using a national database, we assessed the association between NEC and a battery of risk factors previously reported in peer-reviewed literature.

RESULTS: There were 15,072 neonates that met inclusion criteria; 14,682 did not have NEC, while 390 (2.6%) met criterion for NEC. Multivariate analysis showed that low birth weight was the most important risk factor for NEC. Other factors that were associated with an increased risk of NEC were exposure to antenatal glucocorticoids, vaginal delivery, need for mechanical ventilator support, exposure to both glucocorticoids and indomethacin during the first week of life, absence of an umbilical arterial catheter, and low Apgar score at 5 minutes. Length of hospital stay and mortality were higher in neonates with NEC than in neonates without NEC.

CONCLUSIONS: NEC remains an important cause of morbidity and mortality in prematurely born neonates. In contrast to previous studies, we found that exposure to antenatal glucocorticoids was associated with an increased risk for NEC independent of birth weight.

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Acknowledgements

In addition to the authors, the following physicians participated in this study: Harrisburg, PA — K. Lorah; Utica, NY — M. Siriwardena; Wichita, KS — E. Otero, C. Smart; Ft. Lauderdale, FL — S. Haskins; Boca Raton, FL — F. Miller; Coral Springs, FL — G. Melnick; Boynton Beach, FL — L. Whetstine; Denver, CO — E. Berman, D. Eichorst, J. Toney, P. Honeyfield; Houston, TX — R. Rivas, H. Pierantoni, E. O'Donnell; Englewood, CO — K. Zarlengo; West Palm Beach, FL — D. Kanter; Virginia Beach, VA — R. Balcom, E. Bollerup; Frederickburg, VA — J. Amin; Spartanburg, SC — V. Iskersky; Watertown, NY — K. Komar; Tarzana, CA — J. Banks; Ventura, CA — J. van Houten; Hoboken, NJ — M. Dyan; Stratford, NJ — J. Coleman; Trenton, NJ — K. Weiss, R. Axelrod; Fountain Valley, CA — A. Esparza; Covina, CA — V. Chundu, G. Martin; San Luis Obispo, CA — J. Martin; Newport Beach, CA — L. Wickham, B. Hannam; Riverside, CA — M. Leitner; Las Vegas, NV — M. Kaneta; Alexandria, VA — M. Dwyer, L. Goldberg; Albuquerque, NM — R. Nederhoff, S. Swetnam; Aurora, CO — M. Brown; Phoenix, AZ — M. McQueen; Dallas, TX — J. Whitfield, T. Brannon; Roanoke, VA — R. Allen; Dayton, OH — N. Kantor; Ogden, UT — N. Harper; Columbia, SC — S. Ellis; Panama City, FL — D. Sprague; Pensacola, FL — J. Nagel; Reno, NV — G. Yup; Tacoma, WA — J. Mulligan, G. Jordan, R. Knudson; Ponce, PR — E. Ochoa; Barrington, IL — F. Uraizee; Fort Worth, TX — R. Sidebottom, D. Turbeville, M. Stanley; Charleston, WV — S. Maxwell; San Juan, PR — A. Rivera, M. Ortega; Austin, TX — J. Courtney, D. Wermer, J. Scharnberg; San Jose, CA — E. Alderete; Rock Hill, SC — A. Payne; South Bend, IN — R. White; Kansas City, MO — B. Heimes, J. Anderson; Huntington, CA — R. Liberman; Elmira, NY — W. Helmuth, J. Felix.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of Tennessee College of Medicine, Chattanooga Unit, USA

    Scott O Guthrie MD & Victor Thomas MD

  2. Division of Neonatology, Department of Pediatrics, University of Virginia Health Science Center, Charlottesville, Virginia, USA

    Phillip V Gordon MD, PhD

  3. Division of Neonatology, Department of Pediatrics, University of Tennessee College of Medicine, Chattanooga Unit,

    Victor Thomas MD, Joyce Peabody MD & Reese H Clark MD

  4. The Pediatrix-Obstetrix Center for Research and Education, Pediatrix Medical Group, Inc., Sunrise, FL, USA

    Victor Thomas MD, Joyce Peabody MD & Reese H Clark MD

  5. Department of OB/GYN, Regional Perinatal Center, Sacred Heart Women's Hospital and Associate Professor, University of Florida at Pensacola, USA

    James A Thorp MD

Authors
  1. Scott O Guthrie MD
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  2. Phillip V Gordon MD, PhD
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  3. Victor Thomas MD
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  4. James A Thorp MD
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  5. Joyce Peabody MD
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  6. Reese H Clark MD
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From The Pediatrix-Obstetrix Center for Research and Education.

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Guthrie, S., Gordon, P., Thomas, V. et al. Necrotizing Enterocolitis Among Neonates in the United States. J Perinatol 23, 278–285 (2003). https://doi.org/10.1038/sj.jp.7210892

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