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Am J Perinatol 2024; 41(11): 1544-1553
DOI: 10.1055/a-2183-5155
Original Article

Impact of Size for Gestational Age on Multivariate Analysis of Factors Associated with Necrotizing Enterocolitis in Preterm Infants: Retrospective Cohort Study

Mariela Sánchez-Rosado
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
2   Division of Neonatology, Joe DiMaggio Children's Hospital, Hollywood, Florida
,
Jordan D. Reis
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
3   Department of Pediatrics, Baylor Scott and White, Dallas, Texas
,
Mambarambath A. Jaleel
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
,
Kimberly Clipp
4   Department of Pediatrics, Parkland Health and Hospital System, Dallas, Texas
,
Kate L.M. Mangona
5   Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
,
L Steven Brown
4   Department of Pediatrics, Parkland Health and Hospital System, Dallas, Texas
,
David B. Nelson
6   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, and Parkland Health, Dallas, Texas
,
Myra H. Wyckoff
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
,
Diksha Verma
7   University of Texas Southwestern Medical Center, Dallas, Texas
8   Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Isabelle Kiefaber
7   University of Texas Southwestern Medical Center, Dallas, Texas
,
Cheryl S. Lair
4   Department of Pediatrics, Parkland Health and Hospital System, Dallas, Texas
,
Sujir P. Nayak
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
,
Patti J. Burchfield
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
,
Anita Thomas
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
,
Luc P. Brion 
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations
Funding None.
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Abstract

Objective Necrotizing enterocolitis (NEC) primarily affects preterm, especially small for gestational age (SGA), infants. This study was designed to (1) describe frequency and timing of NEC in SGA versus non-SGA infants and (2) assess whether NEC is independently associated with the severity of intrauterine growth failure.

Study Design Retrospective cohort study of infants without severe congenital malformations born <33 weeks' gestational age (GA) carried out from 2009 to 2021. The frequency and time of NEC were compared between SGA and non-SGA infants. Multivariate logistic regression was used to assess whether NEC was independently associated with intrauterine growth restriction. Severe growth restriction was defined as birth weight Z-score <  −2.

Results Among 2,940 infants, the frequency of NEC was higher in SGA than in non-SGA infants (25/268 [9.3%] vs. 110/2,672 [4.1%], respectively, p < 0.001). NEC developed 2 weeks later in SGA than non-SGA infants. In multivariate analysis, the adjusted odds of NEC increased with extreme prematurity (<28 weeks' GA) and with severe but not moderate growth restriction. The adjusted odds of NEC increased with urinary tract infection or sepsis within a week prior to NEC, were lower in infants fed their mother's own milk until discharge, and did not change over five epochs. NEC was independently associated with antenatal steroid (ANS) exposure in infants with birth weight (BW) Z-score < 0.

Conclusion NEC was more frequent in SGA than in non-SGA infants and developed 2 weeks later in SGA infants. NEC was independently associated with severe intrauterine growth failure and with ANS exposure in infants with BW Z-score < 0.

Key Points

  • We studied 2,940 infants <33 weeks' GA.

  • We assessed NEC.

  • NEC was more frequent in SGA infants.

  • NEC occurred 2 weeks later in SGA infants.

  • NEC was associated with severe growth restriction.

Keywords

necrotizing enterocolitis - intrauterine growth failure - small for gestational age - preterm

Data Availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.


Note

M.S-R., J.D.R., D.V., I.K., P.B., L.S.B, L.P.B.: necrotizing enterocolitis in small for SGA versus appropriate for GA (AGA) infants. Poster presentation, PAS, Denver, CO; April 25, 2022.


Authors' Contributions

M.S-R. conceptualized and designed the study, collected and reviewed data from the medical records, and wrote the first draft of the manuscript. L.P.B. conceptualized and designed the study, collected and reviewed data from the medical records. L.P.B. and L.S.B. conducted the statistical analyses. P.B., A.T., I.K., and D.V. extracted data from the EHR. M.S-R., J.D.R., M.A.J., L.P.B., K.C., and C.L. were part of the QI on NEC. All authors participated in the interpretation of the data, critically reviewed the revisions, and approved the final manuscript as submitted.




Publication History

Received: 10 March 2023

Accepted: 27 September 2023

Accepted Manuscript online:
28 September 2023

Article published online:
27 October 2023

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