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Maternal, Neonatal And Feeding Type Factors Associated With Severity Of Necrotizing Enterocolitis, Cheryl Ann Miner

Theses and Dissertations

Objective: To identify statistical associations with necrotizing enterocolitis (NEC) severity as dichotomized into cases with Bell stage II and III disease.
Study Design: We conducted a retrospective study using eight consecutive years of data from a multihospital healthcare system analyzed NEC severity (Bell stage II vs. III).
Results: We identified 220 neonates with stage ≥ II who had 225 separate episodes of NEC (157 stage II and 68 stage III). Those with stage III were born at earlier gestational age (P<0.0001) and lower birth weight (P<0.0001). Diagnosis of NEC occurred on about the same day of life in stage II and stage III cases. Those who developed stage III had significantly higher C-reactive protein (P<0.0001), I/T ratio (P= 0.0005), mean platelet volume (MPV) (P= 0.0001) and lower pH (P<0.0001) and platelet counts (P<0.0001). Transfusions were more common to those who progressed to stage III (P<0.0001). Regression analysis indicated higher odds of stage III in relationship to the volume of RBC transfusions (OR 2.41, {CI 1.85 to 3.11}, P<0.0001) and pasteurized human milk (PHM) (OR 1.32, {CI 1.07 to 1.62}, P = 0.0089). In contrast, feeding early mother's own milk (colostrum) for five days reduced the odds for stage III (OR 0.802, {CI 0.67 to 0.96}, P=0.0170). Those with small bowel resection were less likely to have received mother's own milk before NEC (OR 0.94, {CI 0.89 to 0.99}, P = 0.019) and factors predicting death from NEC were a low pH (OR 2.21, {CI 1.27 to 3.85}, P = 0.0005) and less colostrum (OR 0.96, {CI 0.94 to 0.99}, P = 0.003).
Conclusions: RBC transfusions and PHM increased the odds for stage III NEC, whereas early mother's own milk five days …