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Impact of concomitant necrotizing enterocolitis on mortality in very low birth weight infants with intraventricular hemorrhage



To evaluate the impact of necrotizing enterocolitis (NEC) on mortality in very low birth weight (VLBW) infants with intraventricular hemorrhage (IVH).

Study design

Data were collected on VLBW infants born 2014–2018 at Vermont Oxford Network (VON) centers. NEC and IVH were categorized by severity. Adjusted risk ratios (ARR) for in-hospital mortality were calculated.


This study included 187 187 VLBW infants. Both medical and surgical NEC increased mortality risk compared to those without NEC. Stratification by IVH severity modified this effect (no IVH: ARR 3.04 (95%CI 2.74–3.38) for medical NEC and 4.17 (3.84–4.52) for surgical NEC; mild IVH: ARR 2.14 (1.88–2.44) for medical NEC and 2.49 (2.24–2.78) for surgical NEC; severe IVH: ARR 1.14 (1.03–1.26) for medical NEC and 1.10 (1.02–1.18) for surgical NEC).


The relative impact of NEC on mortality decreased as IVH severity increased. Given the frequent coexistence of NEC and IVH, these data inform multidisciplinary management of these complex patients.

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Fig. 1: Incidence of medical and surgical necrotizing enterocolitis among infants with intraventricular hemorrhage.
Fig. 2: Unadjusted in-hospital mortality in infants with IVH and NEC.
Fig. 3: Forest plot of adjusted risk ratios for in-hospital mortality in infants with IVH and NEC.

Data availability

The code used for this analysis can be made available upon request.


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We thank our colleagues who submit data to VON on behalf of infants and their families. Participating centers are listed in Supplementary Table 1.


Dr. Horbar, Dr. Soll and Ms. Morrow are employees of the Vermont Oxford Network. Dr. Edwards receives salary support from Vermont Oxford Network. The remaining authors do not have financial relationships to disclose.

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Authors and Affiliations



KC was involved in analysis, interpretation of data, drafting of the manuscript, and critical revision of the manuscript. JK, TJ, and BPM were involved in study conception and design, analysis, interpretation of data, and critical revision of the manuscript. GK, EN, and SMH were involved in analysis, interpretation of data, and critical revision of the manuscript. EME and KAM were involved in designing the data collection instruments, the acquisition of the data, interpretation of data, and critical revision of the manuscript. RFS and JDH were involved in coordinating data collection, interpretation of the data, and critical revision of the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Biren P. Modi.

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The authors declare no competing interests.

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Culbreath, K., Knell, J., Keefe, G. et al. Impact of concomitant necrotizing enterocolitis on mortality in very low birth weight infants with intraventricular hemorrhage. J Perinatol (2022).

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