Factors affecting the severity of necrotizing enterocolitis

Objective: The severity of necrotizing enterocolitis (NEC) ranges from mild to rapidly fatal. However, the factors determining the severity are not known. Our objective was to identify statistical associations with NEC severity using a large database. Method: We conducted a retrospective, multi-institutional, multiyear, study of neonates with confirmed NEC. Results: Two-hundred-twenty neonates with Bell's stage >= II NEC had 225 NEC episodes (157 stage II and 68 stage III). In the 3 d before NEC was diagnosed, those who went on to stage III disease were more likely to have elevations in C - reactive protein (p<0.0001), immature to total neutrophil ratio (p=0.0005), and mean platelet volume (p=0.0001), and low pH (p=0.0001) and platelet count (p<0.0001). Regression analysis indicated higher odds that NEC would be severe if there was an antecedent RBC transfusion (p<0.0001) or if the first feedings were not colostrum (p=0.017). The two factors best predicting death from NEC were; (1) a low pH (p=0.0005) and (2) lack of early colostrum (p=0.003). Conclusions: Strategies that reduce the severity of NEC would lower costs and improve outcomes. This study suggests that testable theories to accomplish this include means of; (1) reducing transfusions and (2) assuring early colostrum feedings.