National prospective surveillance study of necrotizing enterocolitis in neonatal intensive care units
Received 15 July 2009; received in revised form 2 December 2009; accepted 3 December 2009.
Abstract
Purpose
There is scant epidemiological data on necrotizing enterocolitis (NEC), so we conducted a national study to characterize prevalence, surgical management, and mortality.
Methods
A prospective cross-sectional survey was performed in the United Kingdom requesting data from 158 level 2 and 3 neonatal intensive care units (NICUs) during 2 winter and 2 summer months in 2005 to 2006; 51% of questionnaires were returned. Results are given as percentage with 95% confidence intervals.
Results
(1) Period prevalence: 211 infants were diagnosed with NEC (45% Bell's stage I, 21% stage II, and 33% stage III) from a total of 10,946 NICU admissions, with a period prevalence of 2% (1.7-2.2). In infants less than 1000 g birth weight, the prevalence was 14% (12-16), and in less than 26 weeks of gestation, 14% (11-17). Prevalence decreased significantly with increasing birth weight (P < .0001) and increasing gestation (P < .0001). (2) Surgery: 66 infants received surgical procedures; peritoneal drain in 13 (followed by laparotomy in 8) and in 53, laparotomy alone. (3) Mortality: 27 infants died with NEC of a total 283 deaths, thus, accounting for 9.5% of NICU mortality. Eight (30%) infants with NEC died without surgery.
Conclusions
Prevalence of NEC in the United Kingdom is high and comparable to published series in other countries from the 1990s. There may be a hidden mortality in patients who do not receive surgery.
Department of Paediatric Surgery, UCL Institute of Child Health and Great Ormond St Hospital, WC1N 1EH London, United Kingdom
Corresponding author. Nuffield Professor of Pediatric Surgery, Pediatric Surgery Unit, Institute of Child Health, WC1N 1EH London, United Kingdom. Tel.: +44 20 7905 2175; fax: +44 20 7404 6181.
ABSTRACT