Risk Factors of Necrotizing Enterocolitis in Preterm Infants: A Single Center Experience

INTRODUCTION: Necrotizing enterocolitis (NEC) is a fatal disease with up to 20% mortality rates. Identifying risk factors for NEC may reduce NEC incidences. This study aims to investigate NEC-related risk factors in preterm infants.
METHODS: We included 27 preterm infants with NEC and 35 infants without NEC among the preterm newborns (n=1669) hospitalized in the Duzce University School of Medicine neonatal intensive care unit between 2009 and 2021. Parametric numeric data were calculated using the independent sample's t-test. Two-sample comparisons of nonparametric data were performed using the Mann-Whitney test. Pearson chi-square, Yates correction, and Fisher's exact test were also used to evaluate the categorical data.
RESULTS: Our results agree with previous studies regarding some of these findings: birth weight is lower in the NEC group (1.37±0.49 kg) than in the non-NEC group (18.3±6.5 kg) (p=0.009), with statistically similar gestational age. We couldn't show the association between NEC and multiple gestations, chorioamnionitis, preeclampsia, Apgar scores, patent ductus arteriosus, mechanical ventilation, pre-NEC red blood cell, or fresh frozen plasma transfusions. In the NEC group, thrombocyte levels before NEC were significantly lower (98 [9-2253]) (/x10³ mm³) than in the control group (222 [17-345]) (/x10³ mm³) (p=0.012). In addition, mortality rates (22.2% vs. 2.9%, respectively) (p=0.037), use of vasopressors (29.6% vs. 2.9%, respectively) (p=0.008) were markedly higher in the NEC group than in the non-NEC group. Additionally, lower birth weight (NEC group: 1367.25±493.62 vs. non-NEC group: 1831.71±651.62) (p=0.009), prolonged use of antibiotics (NEC group: 24% vs. non-NEC group: 0%) (p=0.004), and poor circulation (NEC group: 84% vs. non-NEC group: 3%) (p<0.001) were statistically significant variables.
DISCUSSION AND CONCLUSION: NEC increases the mortality rates in preterm infants. The use of vasopressors, low birth weight, poor circulation, and antibiotics are significant risk factors for NEC, and low thrombocyte levels can lead to the prediction of NEC.