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Predictors of necrotising enterocolitis: can we reduce the incidence and morbidity of this destructive illness in neonates?
  1. K Jefferies,
  2. A Yannoulias
  1. Neonatal Intensive Care Unit, Wexham Park Hospital, Slough, UK

Abstract

Aims Necrotising Enterocolitis (NEC) is the most common gastrointestinal emergency in neonates affecting 1-5% admitted to Neonatal Intensive Care Units (NICU). The population at risk of NEC is expanding as an increasing number of pre-term infants survive the neonatal period.

The aims of this study were to determine the incidence of NEC in a Level 2 NICU and to identify:

  • risk factors that have the greatest impact on the development of NEC;

  • inflammatory markers that are the best predictors of severity;

  • potential ways of preventing NEC.

Method A retrospective study of all neonates diagnosed with suspected and confirmed NEC, according to Bell's Staging Criteria, in a Level 2 NICU between November 2010 and July 2011. For each patient information on risk factors, inflammatory markers and radiological findings was obtained.

Results 22 cases of NEC were diagnosed during the study period. There was 13/22 (59%) confirmed cases with 4/13 (31%) requiring surgical intervention. The gestational age of 95% was ≤33 weeks. 80% of neonates with intrauterine growth restriction had confirmed NEC. The majority of neonates commenced enteral feeds either within the first 24 hours or after day 3. There was little difference in the incidence of confirmed NEC in these groups, 55.6% and 50% respectively. 83% of infants with abnormal antenatal dopplers developed NEC. 16/22 (72.7%) neonates received exclusively maternal breast milk, of those who didn't, 83% were diagnosed with confirmed NEC. Cases of confirmed NEC were typically associated with a high C-reactive protein, low platelet count and low white cell count.

Conclusion Necrotising Enterocolitis is a multifactorial disease with intrauterine growth restriction and abnormal doppler results increasing the risk of developing confirmed NEC. Gestational age also has a significant impact and neonates <33 weeks are particularly vulnerable. Cautiously introducing enteral feeds using expressed maternal breast milk and increasing feed volumes slowly is important in reducing the incidence amongst high risk individuals. The combination of clinical signs, inflammatory markers and radiological findings indicates the disease severity. This should prompt early referral to Tertiary Centres for surgical intervention to help reduce associated morbidity and mortality.

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