EVALUATION RISK FACTORS OF NECROTIZING ENTEROCOLITIS

CHILDREN HOSPITAL AND THE INSTITUTE OF CHILD HEALTH MULTAN.

Abstract

Introduction: Necrotizing enterocolitis (NEC) is a condition where the intestines
become infected and can begin to die. Necrotizing enterocolitis is a serious condition that may
require surgery, and has a high morbidity and mortality rate. Objectives: To evaluate the risk
factors of necrotizing enterocolitis among neonates at children hospital Multan. Study Design:
Descriptive Cross-sectional study. Setting: Neonatal Unit of Children Hospital and Institute of
Child Health Multan. Period: October 2015 to September 2016. Material and Methods: A total of
79 neonates presented with necrotizing enterocolitis were enrolled for the possible causes. The
parameters studied included gestational age at birth, birth weight, maternal risk factors, patient
risk factors, age when feeding was started, type of feed, age when signs of NEC appeared,
per feed increment, presence of any antecedent associations, clinical features, radiological
features, blood investigations (complete blood counts, blood glucose, serum sodium, serum
potassium, serum creatinine, liver function tests), ABGs, stool for occult blood and culture,
septic screening and blood culture, management(medical or surgical) and outcome. The data
was analyzed using SPSS-20. Results: Out of a total of 79 neonates, 48 (60.8%) were male
and 31(39.2%) female. There were 71% infants who were younger than 32 gestational weeks
and 67.7% under 1500 grams. The majority of neonates 62 (78.5%) commenced enteral feeds
within the first 24 hours. First feeding was started at a mean 5.6 ± 3.85 (2-17) days. Prematurity
was the commonest factor and present in 63 (79.9%) neonates. Abdominal distention was the
commonest symptoms 55% followed by bilious vomiting in 15%. Blood culture was positive in
22 (27.8%) with predominance of gram negative microorganisms. According to Bell’s staging,
54 (68.35%) neonates had stage I, 17 (21.5%) stage II, and 8 (10.1%) neonates were in stage
III. Conclusion: In most of the cases, the causes of necrotizing enterocolitis were present
and prematurity was the main etiological factor. Cautiously introducing enteral feeds using
expressed maternal breast milk and increasing feed volumes slowly is important in reducing
the incidence amongst high risk individuals.