Necrotizing enterocolitis carries increased risk of intestinal failure
Intestinal failure (IF) commonly occurs in infants with necrotizing enterocolitis, a study has shown. Other risk factors include extreme preterm birth, a history of abdominal surgery and small for gestational age.
Researchers examined a cohort of 720 infants diagnosed with NEC and 3,656 controls matched by gestational age and year of birth. The cohort was censored at death, IF or at end of follow-up (2 years of age).
Compared with controls, more infants with NEC belonged to the lowest GA category (37.4 percent vs 29.1 percent; p<0.01), had a birth weight <1,500 g (58.3 percent vs 48.4 percent; p<0.01), had higher neonatal mortality (≤28 days; 14.9 percent vs 8.3 percent; p<0.001) and underwent abdominal surgery (21.8 percent vs 2.2 percent; p<0.01).
The cumulative IF incidence was 6.0 percent in the NEC group vs 0.4 percent in the control group. Cox regression showed NEC to be associated with a sevenfold increased risk of developing IF (univariate hazard ratio [HR], 15.9; 95 percent CI, 9.0–28.3; multivariable HR, 7.2; 3.7–14.0).
Other factors associated with a heightened risk of incident IF were small for gestational age, extreme preterm birth and abdominal surgery. Neonatal mortality in infants with NEC dropped from 20.6 percent in 1987–1993 to 10.4 percent in 2007–2009.
Researchers noted that IF was more common in the infants born at the end of the study period, potentially explained by better neonatal survival. Therefore, increased efforts are needed to reduce post-NEC complications such as IF.