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Late onset of necrotizing enterocolitis in the full-term infant is associated with increased mortality: Results from a two-center analysis

  • Scott S. Short
    Affiliations
    Division of Pediatric Surgery, Children’s Hospital Los Angeles, and the Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA

    Division of Pediatric Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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  • Stephanie Papillon
    Affiliations
    Division of Pediatric Surgery, Children’s Hospital Los Angeles, and the Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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  • Dror Berel
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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  • Henri R. Ford
    Affiliations
    Division of Pediatric Surgery, Children’s Hospital Los Angeles, and the Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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  • Philip K. Frykman
    Affiliations
    Division of Pediatric Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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  • Akemi Kawaguchi
    Correspondence
    Corresponding author at: Division of Pediatric Surgery, Children’s Hospital Los Angeles, 4650 Sunset Blvd, MS 100, Los Angeles, CA 90027. Tel.: +1 323 361 5065.
    Affiliations
    Division of Pediatric Surgery, Children’s Hospital Los Angeles, and the Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Published:February 07, 2014DOI:https://doi.org/10.1016/j.jpedsurg.2014.01.028

      Abstract

      Purpose

      The effect of timing of onset of necrotizing enterocolitis (NEC) on outcomes has not been determined for the full-term infant. In this study we aimed to characterize the full-term NEC population and to evaluate onset of NEC.

      Methods

      We performed a two-center retrospective review of all full-term infants (≥ 37 weeks) with a diagnosis of NEC between 1990 and 2012. Patients were identified by ICD-9 and age. Early onset for NEC was ≤7 days and late onset after 7 days of life. Demographics, comorbidities, maternal factors, clinical factors, surgical intervention, complications, and mortality were evaluated. Wilcoxon’s test was performed on continuous variables and Fisher’s exact test on categorical data. A p-value < 0.05 was considered significant. Univariate outcomes with a p-value < 0.1 were selected for multivariable analysis.

      Results

      Thirty-nine patients (24 boys, 15 girls) with median EGA of 39 weeks were identified. Overall mortality was 18%. Univariate predictors of mortality included congenital heart disease and placement of an umbilical artery (UA) catheter. Multivariate analysis revealed late onset of NEC to be an independent predictor of mortality (OR 90.8, 95% CI 2.6–3121).

      Conclusion

      Full-term infants who develop NEC after 7 days of life, have congenital heart disease, and/or need UA catheterization have increased mortality.

      Key words

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