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American Academy of Pediatrics
Article

Incidence and Timing of Presentation of Necrotizing Enterocolitis in Preterm Infants

Wendy H. Yee, Amuchou Singh Soraisham, Vibhuti S. Shah, Khalid Aziz, Woojin Yoon, Shoo K. Lee and the Canadian Neonatal Network
Pediatrics February 2012, 129 (2) e298-e304; DOI: https://doi.org/10.1542/peds.2011-2022
Wendy H. Yee
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Amuchou Singh Soraisham
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Vibhuti S. Shah
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Khalid Aziz
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Woojin Yoon
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Shoo K. Lee
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Abstract

OBJECTIVES: To examine the variation in the incidence and to identify the timing of the presentation of necrotizing enterocolitis (NEC) in a cohort of preterm infants within the Canadian Neonatal Network (CNN).

METHODS: This was a population-based cohort of 16 669 infants with gestational age (GA) <33 weeks, admitted to 25 NICUs participating in the CNN between January 1, 2003, and December 31, 2008. Variations in NEC incidence among the participating NICUs for the study period were examined. We categorized early-onset NEC as occurring at <14 days of age and late-onset NEC occurring at ≥14 days. Multivariate logistic regression analysis was performed to identify risk factors for early-onset NEC.

RESULTS: The overall incidence of NEC was 5.1%, with significant variation in the risk adjusted incidence among the participating NICUs in the CNN. Early-onset NEC occurred at a mean of 7 days compared with 32 days for late-onset NEC. Early-onset NEC infants had lower incidence of respiratory distress syndrome, patent ductus treated with indomethacin, less use of postnatal steroids, and shorter duration of ventilation days. Multivariate logistic regression analysis identified that greater GA and vaginal delivery were associated with increased risk of early-onset NEC.

CONCLUSIONS: Among infants <33 weeks’ gestation, NEC appears to present at mean age of 7 days in more mature infants, whereas onset of NEC is delayed to 32 days of age in smaller, lower GA infants. Further studies are required to understand the etiology of this disease process.

KEY WORDS
  • necrotizing enterocolitis
  • preterm infant
  • incidence
  • Abbreviations:
    BW —
    birth weight
    CNN —
    Canadian Neonatal Network
    GA —
    gestational age
    IVH —
    intraventricular hemorrhage
    NEC —
    necrotizing enterocolitis
    PDA —
    patent ductus arteriosus
    RDS —
    respiratory distress syndrome
    SGA —
    small for gestational age
    SIP —
    spontaneous intestinal perforation
    SNAP-II —
    Score for Neonatal Acute Physiology, version II
    VLBW —
    very low birth weight
    • Accepted October 11, 2011.
    • Copyright © 2012 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 129, Issue 2
    1 Feb 2012
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    Incidence and Timing of Presentation of Necrotizing Enterocolitis in Preterm Infants
    Wendy H. Yee, Amuchou Singh Soraisham, Vibhuti S. Shah, Khalid Aziz, Woojin Yoon, Shoo K. Lee, the Canadian Neonatal Network
    Pediatrics Feb 2012, 129 (2) e298-e304; DOI: 10.1542/peds.2011-2022

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    Incidence and Timing of Presentation of Necrotizing Enterocolitis in Preterm Infants
    Wendy H. Yee, Amuchou Singh Soraisham, Vibhuti S. Shah, Khalid Aziz, Woojin Yoon, Shoo K. Lee, the Canadian Neonatal Network
    Pediatrics Feb 2012, 129 (2) e298-e304; DOI: 10.1542/peds.2011-2022
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