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Abstract
BackgroundNecrotizing enterocolitis (NEC) is a severe multifactorial disease in preterm neonates associated with high morbidity and mortality. Better insight into prognostic values of the many reported factors associated with NEC is needed to enable identification of neonates at risk for NEC. The aim was to systematically review the literature to identify independent risk factors for NEC from the literature.MethodsMedline, Cochrane, Embase, Pubmed and Google Scholar were searched systematically for cohort studies reporting prognostic factors for NEC in neonates using multivariable analysis. Studies were scored with the Quality In Prognosis Studies tool (QUIPS).ResultsFrom 5154 initial hits, 14 prognostic studies were included, with various designs. Study quality was rated high in three studies, moderate or low in the 11 others. Significant prognostic factors for NEC reported in at least two studies were: low birth weight, small for gestational age, low gestational age, assisted ventilation, premature rupture of membranes, black ethnicity, sepsis, outborn, hypotension (all increased risk), surfactant therapy (conflicting results) and cesarean section (lower risk). Meta-analysis was considered not feasible.ConclusionHigh quality studies on prognostic factors for NEC are rare. Several prognostic factors, that are not necessarily causal, are associated with NEC. High quality prognostic research is necessary to establish the predictive values of these factors.
Highlights
Necrotizing enterocolitis (NEC) is a severe multifactorial disease in preterm neonates associated with high morbidity and mortality
An initial search was conducted in January 2014 and updated in August 2016, using terms related to necrotizing enterocolitis, intestinal perforation, neonates, birth weight, gestation, prediction, prognosis, epidemiology and risk factors
Studies were included for analysis if satisfying all following criteria: (1) full English written publications, (2) with a prospective or retrospective cohort study or nested case-control design (3) identifying prognostic factors for NEC, (4) using multivariable data analysis including more than 2 co-variates, (5) in a study population of neonates/newborns, preterm infants, very low birth weight (VLBW) or extremely low birth weight (ELBW) infants
Summary
Necrotizing enterocolitis (NEC) is a severe multifactorial disease in preterm neonates associated with high morbidity and mortality. Necrotizing enterocolitis (NEC) is one of the most severe complications of preterm birth occurring in 5–10% of very low birth weight infants [1, 2]. Surgical treatment is often needed, and survivors are at increased risk for poor long-term growth and neurodevelopmental impairment [5]. Despite preventive strategies such as prenatal glucocorticoid administration, breast feeding, use of donor milk and probiotic supplementation, NEC is still relatively common in most neonatal intensive care units (NICUs) [6,7,8,9,10]. A common inflammatory pathway leads to intestinal ischemia, pneumatosis, necrosis and eventually perforation [11]
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