Risk factors for developing and dying from necrotizing enterocolitis

A case-control study was performed to identify risk factors for developing and dying from necrotizing enterocolitis (NEC). Eighty-six infants observed at The Johns Hopkins Hospital who had clinical and/or pathological evidence of this disease during the past 10 years were studied. Birth weight matched autopsied control infants without NEC were also studied for comparison with the autopsied infants who died with NEC. Patients with NEC had a mean birth weight of 1,620 ± 198 g, and those who died from NEC had even lower birth weights (1,418 ± 109 g). The development of NEC was correlated with significantly higher frequencies of oral feeding (p <0.005) and septicemia (p <0.001). Death with NEC was correlated with earlier onset and more extensive disease (both p <0.05), hypotension (p <0.001), septicemia (p <0.001), persistent respiratory distress (p <0.05), a patent ductus arteriosus (p <0.05), and lower 5-min Apgar scores (p <0.05). These findings suggest that NEC is caused by overwhelming hypotensive/ischemic injury to the intestines in association with en-terosepticemia. Intestinal immaturity and oral feedings appear to be important predisposing factors in this condition.