Abstract
Objective We characterize the most recent natural history of necrotizing enterocolitis (NEC),
as this is an essential first step in guiding the prevention and treatment of this
disease in the present day.
Study Design We performed a retrospective cohort study of neonates who were born at 23 to 29 weeks'
gestation and birth weight <1,500 g who received care from the Pediatrix Medical Group
between 2004 and 2019. We assessed the incidence of medical and surgical NEC and the
patterns of initial antibiotic treatment to develop a contemporary cohort for further
analysis. Among patients discharged between 2015 and 2019, we characterized the stage-specific
risk factors for patients diagnosed with medical or surgical NEC, as well as patterns
of disease onset, progression, biomarkers, and outcomes. We used the same approach
to characterize patients diagnosed with suspected NEC.
Results Among 34,032 patients in the contemporary cohort, 1,150 (3.4%) were diagnosed with
medical NEC and 543 (1.6%) were diagnosed with surgical NEC. The temporal pattern
of disease onset was different for medical and surgical NEC, with gestational age–
and birth weight–specific risk disparities emerging earlier in surgical NEC. Thirty-day
mortality was much greater among surgical NEC patients (medical NEC 16.4% vs. surgical
NEC 43.0%), as were rates of various in-hospital and long-term outcomes. Suspected
NEC was diagnosed in 1,256 (3.7%) patients, among whom risk factors and disease onset,
progression, and outcomes closely resembled those of medical NEC.
Conclusion Analyzing data from a contemporary cohort enabled us to characterize the current,
stage-specific natural history of NEC, including novel insights into suspected NEC.
Future studies could leverage this cohort to characterize how specific patient characteristics,
care processes, or biomarkers may influence or predict disease outcomes.
Key Points
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The incidence of NEC has reached a stable baseline in recent years.
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Risk factors for NEC vary in a stage-specific manner.
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The stage-specific onset and progression of NEC differ by gestational age and birth
weight.
Keywords
necrotizing enterocolitis - neonate - very low birth weight - prematurity - natural
history
