Summary
Purpose
To determine what modifiable interventions used in the neonatal intensive care unit
(NICU) are associated with severe necrotizing enterocolitis (NEC) requiring surgical
intervention.
Methods
A retrospective review of patients treated for NEC at a tertiary hospital from 1991-2016
was performed. Patient characteristics were used to calculate propensity scores for
likelihood of exposure to seven interventions: enteral feeds, use of glucocorticoids,
nonsteroidal anti-inflammatory drugs (NSAIDs), antacids, antibiotics, or umbilical
arterial (UAC) and venous catheters (UVC). Conditional logistic regression was used
to compare the odds of having surgical NEC if exposed to each treatment.
Results
We included 195 NEC patients: 69 severe NEC managed with surgery and 126 non-severe
NEC managed medically. After propensity score matching based on birth characteristics,
exposure to glucocorticoids (OR 5.21, 95%CI: 1.62, 16.70), NSAIDs (OR 4.87, 95%CI:
1.67, 14.17), UVC (OR 2.53 (95%CI: 1.19, 5.73), and UAC (OR 4.91, 95%CI: 2.12, 11.37)
were associated with surgical NEC in separate conditional logistic regression analyses.
Including these treatments in a second round of propensity matching and conditional
logistic regression revealed that glucocorticoids, (OR 2.99, 95%CI: 1.01, 8.88), NSAIDs
(OR 3.97, 95%CI: 1.41, 11.19), UVC (OR 3.07, 95%CI: 1.46, 6.48), and UAC (OR 5.10,
95%CI: 2.10, 12.36) were still associated with surgical NEC.
Conclusion
After controlling for birth confounders and common NICU supportive interventions,
use of glucocorticoids, NSAIDs and umbilical catheters independently increased the
odds of developing severe NEC requiring surgical intervention.
Level-of-Evidence rating
Case-control, Level III evidence.
Keywords
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Article info
Publication history
Accepted:
January 3,
2023
Received:
December 31,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
