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Fulminant necrotizing enterocolitis in a multihospital healthcare system

Journal of Perinatology volume 32, pages 194–198 (2012)Cite this article

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Abstract

Objective:

A subset of necrotizing enterocolitis (NEC) cases is fulminant, characterized by rapid progression to death with massive bowel necrosis found at laparotomy or autopsy. We sought to identify and report all such cases in a multihospital healthcare system during the past 9 years and to characterize this entity using case-control methodologies.

Study Design:

This was a multicentered, cross-sectional, historic cohort study conducted using Intermountain Healthcare hospital patient data. All neonates who died of NEC within 48 h of onset, during 2001 to 2009, were compared with two matched control groups: (1) demographically matched controls who developed non-fulminant NEC, (2) demographically matched controls that did not develop NEC.

Result:

During this period, 2 71 327 live births occurred in the Intermountain Healthcare hospitals. Of these, 318 had a diagnosis of NEC (Bell stage ⩾II). Also during this period, 205 other neonates were transferred into an Intermountain hospital for treatment of NEC. Of these 523 NEC cases, 35 (6.7%) had a fulminant course. Compared with the non-fulminant cases, the fulminant group were born at lower weight (1088±545 vs 1652±817 g, P=0.000) and earlier gestational age (27.5±3.3 vs 31.1±4.4 weeks, P=0.000), and were more likely to have: (1) radiographic evidence of portal venous air (P=0.000), (2) hematocrit <22% (P=0.000), (3) increase in feeding volume >20 ml/kg/day (P=0.003), (4) immature to total (I/T) neutrophil ratio >0.5 (P=0.005), (5) blood lymphocyte count <4000/μl (P=0.018), (6) an increase in concentration of human milk fortifier within 48 h before developing NEC (P=0.020).

Conclusion:

Portal venous air, anemia, rapid feeding escalation, a high I/T neutrophil ratio, a low lymphocyte count and recent increases in fortifier may all be associated with fulminant NEC.

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Authors and Affiliations

  1. Women and Newborns Program, Intermountain Healthcare, Salt Lake City, UT, USA

    D K Lambert, R D Christensen, V L Baer, E Henry, J Wilkes, S E Wiedmeier & E Gerday

  2. Division of Neonatology, McKay-Dee Hospital Center, Ogden, UT, USA

    D K Lambert, R D Christensen & V L Baer

  3. Institute for Healthcare Delivery Research, Salt Lake City, UT, USA

    E Henry & J Wilkes

  4. Division of Neonatology, Department of Pediatrics, Tulane School of Medicine, New Orleans, LA, USA

    P V Gordon

  5. Department of Surgery, Nationwide Children's Hospital, Columbus, USA, OH

    G E Besner

  6. Division of Neonatology, Intermountain Medical Center and Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA

    S E Wiedmeier

  7. Division of Neonatology, Utah Valley Regional Medical Center, Provo, UT, USA

    E Gerday

Authors
  1. D K Lambert
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  2. R D Christensen
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  3. V L Baer
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  4. E Henry
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  5. P V Gordon
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  6. G E Besner
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  7. J Wilkes
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Corresponding author

Correspondence to R D Christensen.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Lambert, D., Christensen, R., Baer, V. et al. Fulminant necrotizing enterocolitis in a multihospital healthcare system. J Perinatol 32, 194–198 (2012). https://doi.org/10.1038/jp.2011.61

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  • DOI: https://doi.org/10.1038/jp.2011.61

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