Prevalence and risk factors associated with the need for surgical intervention due to necrotizing enterocolitis in very low birth weight infants

INTRODUCTION

Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal emergencies affecting very low birth weight (VLBW) infants with an incidence of 6-15 %. Early recognition is crucial. Mortality is high and variable (30-50 %). Those requiring surgical intervention have a higher mortality rate than those who receive medical treatment.

OBJECTIVES

1) To assess the prevalence of surgical NEC and associated risk factors 2) To compare outcomes based on the type of treatment required 3) To estimate the mortality associated with NEC and surgical NEC.

METHODS

A multicentre retrospective cohort study was designed (level II), including VLBW infants born between 2011 and 2020 in Centers of the Neocosur Network. A multivariate logistic regression analysis was performed to evaluate risk factors associated with the need for surgery.

RESULTS

NEC was diagnosed in 1679 (10.4 %) of 16,131 births in this period. The prevalence of surgery was 25 % (95 % CI 23-27 %). In multivariable analysis, variables associated with an increased risk of surgery requirement were birth weight <750 g (aOR 1.73-95%CI 1.2-2.5) and receiving antenatal antibiotics (aOR 1.54-95%CI 1.09-2.74). Those requiring surgery had significantly higher morbidity and mortality than the ones receiving medical treatment.

CONCLUSION

In VLBW infants with NEC, lower birth weight and antenatal antibiotics administration were independently associated with the need for surgical intervention.

Early hypophosphatemia in preterm infants receiving aggressive parenteral nutrition

OBJECTIVE

To report the prevalence of hypophosphatemia during the first week of life in preterm infants receiving aggressive parenteral nutrition and to analyze population variables associated with severe hypophosphatemia.

STUDY DESIGN

A retrospective cohort of 61 neonates below 1250 g birth weight consecutively born at Hospital Italiano de Buenos Aires exposed to high caloric and protein intake from the first day of birth. Primary outcome was hypophosphatemia (phosphate <4 mg dl(-1)). A one-sample mean comparison test was used to compare our sample with a hypothesized population mean.

RESULTS

The prevalence of hypophosphatemia was 91% (95% confidence interval (CI) 82 to 97%). The mean phosphatemia value was 2.52 mg dl(-1) (95% CI 2.18 to 2.86), significantly different from the hypothesized population mean (P<0.001). Patients with severe hypophosphatemia (<2 mg dl(-1)) were smaller. They presented with sepsis more frequently and received more vasoactive drugs and mechanical ventilation.

CONCLUSION

The prevalence of hypophosphatemia in this group of preterm infants is high. The potential association with adverse clinical outcomes deserves further research.