79 Variation in Incidence of Necrotizing Enterocolitis in Canadian Neonatal Intensive Care Units

Abstract

Necrotizing enterocolitis (NEC) is the most common acquired neonatal intestinal pathology. Most previous reports of NEC have involved only small groups of a sub-population of neonatal intensive care units (NICU), such as extremely low birth weight infants, and did not examine risk-adjusted variations in incidence among NICUs. Our aim was to examine risk-adjusted variations in the incidence of NEC in a large group of Canadian NICUs, and to explore potentially associated therapy-related risks. We examined 16,883 infants admitted to 17 tertiary level Canadian NICUs from January 1996 to October 1997. We used multivariate logistic regression analysis to examine the inter-NICU variation in incidence of NEC, with adjustment for population risk factors and admission illness severity, and explored therapy-related variables. The incidence of NEC was 6.6% (n=238) among 3,628 infants with birth weight <1500 grams, and 0.7% (n=98) among 14,606 infants with birth weight >1500 grams. Multivariate logistic regression analysis showed NEC was associated with infants with lower gestational age, need for assisted ventilation and treatment of patent ductus arteriosus. The presence of congenital anomalies was also predictive for infants born with birth weights >1500 g. There was no significant variation in the risk adjusted incidence of NEC among NICUs, with the exception of 1 NICU reporting no cases of NEC. Risk factors for NEC were different among infants with birth weights less than and more than 1500 g. There was no significant variation in the risk-adjusted incidence of NEC among Canadian NICUs, with one possible exception. Incidence (%) of necrotizing enterocolitis by birth weight group. Birth weight measured in grams.