Abstract
Objective:
Model age of necrotizing enterocolitis (NEC) onset applying Sartwell's model of incubation periods, and examine its relationship to gestational age (GA).
Study Design:
Retrospective chart review of St Louis Children's Hospital neonates diagnosed with NEC (⩾Bell's stage II) from 2004 to 2008, inclusive.
Result:
The relationship between age of NEC (N=84 cases) onset and GA best fits a non-linear model, with infants ⩽28 weeks having a disproportionately longer time to onset than older GA groups and explained 50.3% of the variability in age of NEC onset. Additional clinical variables provided no improvement in explaining age of NEC onset. Application of Sartwell's model to age of NEC onset proved a good fit, when birth is used as the common exposure episode, and age is equivalent of the incubation period.
Conclusion:
The relationship between day of NEC diagnosis and GA is non-linear, with lower GA infants having disproportionately longer time to onset. Despite these GA differences, the fit to Sartwell's model for incubation periods model is consistent with NEC being a consequence of an event that occurs at or soon after birth.
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Acknowledgements
We wish to thank the late Dr David Alling for his insight and wisdom regarding incubation period distributions, and Beth Wolf, Gina Meyers, Amy Distler and Christine Musser for assistance with manuscript preparation. Ms González-Rivera was supported by the Doris Duke Clinical Research Foundation. Dr Warner received support from the Children's Discovery Institute MD II-2009-201. Drs Tarr and Warner were partially supported by UH2 AI083265 and DDRCC grant 5P30 DK052574 to Washington University Digestive Diseases Research Core Center. Drs Warner and Hamvas received support from the Washington University Institute for Clinical and Translational Studies (UL1 RR024992). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or NIH. Dr Culverhouse is partially supported by the National Institute of General Medical Sciences (K25 GM69590).
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González-Rivera, R., Culverhouse, R., Hamvas, A. et al. The age of necrotizing enterocolitis onset: an application of Sartwell's incubation period model. J Perinatol 31, 519–523 (2011). https://doi.org/10.1038/jp.2010.193
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DOI: https://doi.org/10.1038/jp.2010.193
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