Skip to main content

Advertisement

SpringerLink
Log in

Early versus late-onset necrotizing enterocolitis in very low birth infants in the neonatal intensive care unit

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Background

Necrotizing enterocolitis (NEC), one of the most severe emergencies in neonates, is a multifactorial disease with diverse risk factors.

Objectives

To compare between the clinical and laboratory characteristics of premature infants diagnosed with early-onset NEC (EO-NEC) and those with late-onset NEC (LO-NEC).

Patients and methods

Enrolled infants were identified from prospective local data collected for the Israel National very low birth weight (VLBW, < 1500 g) infant database and from the local electronic patient files data base for the period 1996–2017.

Results

Overall, 95 VLBW infants (61, 64.21% EO-NEC and 34, 35.87% LO-NEC) were enrolled. EO-NEC infants had higher rate of IVH grade 3 and 4 (26.2% vs 2.9%, p = 0.005) and were more likely to undergo surgery (49.2% vs 26.5%, p = 0.031). LO-NEC infants had a higher incidence of previous bloodstream infections (35.3% vs 8.2%, p = 0.002) compared to EO-NEC. In multivariable analysis models, surgical intervention was associated with EO-NEC (OR: 4.627, p = 0.013) as well as PDA and positive blood culture prior to the NEC episode.

Conclusions

Our data support the hypothesis that EO-NEC has significant different clinical and microbiological attributes compared to LO-NEC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

BPD:

Bronchopulmonary dysplasia

BSI:

Blood stream infection

CONS:

Coagulase negative staphylococci

cPVL:

Cystic periventricular leukomalacia

EO:

Early onset

GA:

Gestational age

IVH:

Intra-ventricular hemorrhage

IQR:

Interquartile range

LO:

Late onset

NEC:

Necrotizing enterocolitis

PDA:

Patent ductus arteriosus

RDS:

Respiratory distress syndrome

ROP:

Retinopathy of prematurity

SD:

Standard deviation

References

  1. Neu J (1996) Necrotizing enterocolitis: the search for a unifying pathogenic theory leading to prevention. Pediatr Clin North Am 43:409–432

    Article  CAS  Google Scholar 

  2. Samuels N, van de Graaf RA, de Jonge RCJ, Reiss IKM, Vermeulen MJ (2017) Risk factors for necrotizing enterocolitis in neonates: a systematic review of prognostic studies. BMC Pediatr 17:105

    Article  Google Scholar 

  3. Berkhout DJC, Klaassen P, Niemarkt HJ, de Boode WP, Cossey V, van Goudoever JB, Hulzebos CV, Andriessen P, van Kaam AH, Kramer BW, van Lingen RA, Vijlbrief DC, van Weissenbruch MM, Benninga M, de Boer NKH, de Meij TGJ (2018) Risk factors for necrotizing enterocolitis: a prospective multicenter case-control study. Neonatology 114:277–284

    Article  Google Scholar 

  4. Kosloske AM (1984) Pathogenesis and prevention of necrotizing enterocolitis: a hypothesis based on personal observation and a review of the literature. Pediatrics 74:1086–1092

    Article  CAS  Google Scholar 

  5. Kosloske AM (1994) Epidemiology of necrotizing enterocolitis. Acta paediatrica (Oslo, Norway: 1992) Suppl 396:2–7

    Article  CAS  Google Scholar 

  6. Horbar JD, Edwards EM, Greenberg LT, Morrow KA, Soll RF, Buus-Frank ME, Buzas JS (2017) Variation in performance of neonatal intensive care units in the United States. JAMA Pediatr 171:e164396

    Article  Google Scholar 

  7. Allin BSR, Long AM, Gupta A, Lakhoo K, Knight M (2018) One-year outcomes following surgery for necrotising enterocolitis: a UK-wide cohort study. Arch Dis Child Fetal Neonatal Ed 103:F461–f466

    Article  Google Scholar 

  8. Neu J, Walker WA (2011) Necrotizing enterocolitis. N Engl J Med 364:255–264

    Article  CAS  Google Scholar 

  9. Moss RL, Kalish LA, Duggan C, Johnston P, Brandt ML, Dunn JC, Ehrenkranz RA, Jaksic T, Nobuhara K, Simpson BJ, McCarthy MC, Sylvester KG (2008) Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study. J Perinatol 28:665–674

    Article  CAS  Google Scholar 

  10. Yee WH, Soraisham AS, Shah VS, Aziz K, Yoon W, Lee SK (2012) Incidence and timing of presentation of necrotizing enterocolitis in preterm infants. Pediatrics 129:e298-304

    Article  Google Scholar 

  11. Li QY, An Y, Liu L, Wang XQ, Chen S, Wang ZL, Li LQ (2017) Differences in the clinical characteristics of early- and late-onset necrotizing enterocolitis in full-term infants: a retrospective case-control study. Sci Rep 7:43042

    Article  CAS  Google Scholar 

  12. Levitzky O, Lerner-Geva L, Dollberg S, Reichman B (2016) The israel national very low birth weight infant database. Harefuah 155(32–36):67

    Google Scholar 

  13. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, Brotherton T (1978) Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 187:1–7

    Article  CAS  Google Scholar 

  14. Bizzarro MJ, Ehrenkranz RA, Gallagher PG (2014) Concurrent bloodstream infections in infants with necrotizing enterocolitis. J Pediatr 164:61–66

    Article  Google Scholar 

  15. Limperopoulos C, Gauvreau KK, O’Leary H, Moore M, Bassan H, Eichenwald EC, Soul JS, Ringer SA, Di Salvo DN, du Plessis AJ (2008) Cerebral hemodynamic changes during intensive care of preterm infants. Pediatrics 122:e1006–1013

    Article  Google Scholar 

  16. Dolfin T, Skidmore MB, Fong KW, Hoskins EM, Shennan AT (1983) Incidence, severity, and timing of subependymal and intraventricular hemorrhages in preterm infants born in a perinatal unit as detected by serial real-time ultrasound. Pediatrics 71:541–546

    Article  CAS  Google Scholar 

  17. Enzmann D, Murphy-Irwin K, Stevenson D, Ariagno R, Barton J, Sunshine P (1985) The natural history of subependymal germinal matrix hemorrhage. Am J Perinatol 2(2):123–133

    Article  CAS  Google Scholar 

  18. Li X, Li L, Wang Y, Deng C, Guo C (2017) Postoperative characteristics of infants who developed necrotizing enterocolitis with different postnatal ages. Medicine (Baltimore) 96(32):e7774. https://doi.org/10.1097/MD.0000000000007774 (PMID: 28796074; PMCID: PMC5556240)

    Article  Google Scholar 

  19. Josephson CD, Wesolowski A, Bao G, Sola-Visner MC, Dudell G, Castillejo MI, Shaz BH, Easley KA, Hillyer CD, Maheshwari A (2010) Do red cell transfusions increase the risk of necrotizing enterocolitis in premature infants? J Pediatr 157(6):972-978.e1–3. https://doi.org/10.1016/j.jpeds.2010.05.054 (Epub 2010 Jul 21. PMID: 20650470; PMCID: PMC4425198)

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zhou Y, Shan G, Sodergren E, Weinstock G, Walker WA, Gregory KE (2015) Longitudinal analysis of the premature infant intestinal microbiome prior to necrotizing enterocolitis: a case-control study. PLoS One 10(3):e0118632. https://doi.org/10.1371/journal.pone.0118632.PMID:25741698;PMCID:PMC4351051

    Article  PubMed  PubMed Central  Google Scholar 

  21. Picaud JC, De Magistris A, Mussap M, Corbu S, Dessì A, Noto A, Fanos V, Cesare MF (2021) Urine NMR metabolomics profile of preterm infants with necrotizing enterocolitis over the first two months of life: a pilot longitudinal case-control study. Front Mol Biosci 15(8):680159. https://doi.org/10.3389/fmolb.2021.680159.PMID:34212004;PMCID:PMC8239193

    Article  Google Scholar 

Download references

Acknowledgements

This study was part of the MD degree requirements of Dr. Simona Yoffe Deri in Ben Gurion University of the Negev.

Funding

No funding was received for the purpose of this study.

Author information

Author notes

  1. Simona Yoffe Deri and Rimma Melamed contributed equally to the study.

Authors and Affiliations

  1. Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel

    Simona Yoffe Deri

  2. Faculty of Health Sciences, Pediatrics Division, Ben Gurion University of the Negev, Beer Sheva, Israel

    Rimma Melamed, Kyla Marks, Eugene Leibovitz, Agneta Golan & Eilon Shany

  3. Pediatric Infectious Diseases Unit, Soroka Medical Center, Beer Sheva, Israel

    Rimma Melamed & Eugene Leibovitz

  4. Neonatal Department, Soroka Medical Center, P.O. Box 151, 84101, Beer Sheva, Israel

    Kyla Marks, Agneta Golan & Eilon Shany

  5. Soroka Research Center, Beer Sheva, Israel

    Yuval Mizrakli

Authors
  1. Simona Yoffe Deri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rimma Melamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyla Marks
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuval Mizrakli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eugene Leibovitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Agneta Golan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eilon Shany
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eilon Shany.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoffe Deri, S., Melamed, R., Marks, K. et al. Early versus late-onset necrotizing enterocolitis in very low birth infants in the neonatal intensive care unit. Pediatr Surg Int 38, 235–240 (2022). https://doi.org/10.1007/s00383-021-05029-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-021-05029-3

Keywords

Search

Navigation