Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

Daniel J. C. Berkhout; Patrick Klaassen; Hendrik J. Niemarkt; Willem P. de Boode; Veerle Cossey; Johannes B. van Goudoever; Christiaan V. Hulzebos; Peter Andriessen; Anton H. van Kaam; Boris W. Kramer; Richard A. van Lingen; Daniel C. Vijlbrief; Mirjam M. van Weissenbruch; Marc Benninga; Nanne K. H. de Boer; Tim G. J. de Meij

doi:10.1159/000489677

Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

Daniel J. C. Berkhout^*, Patrick Klaassen, Hendrik J. Niemarkt, Willem P. de Boode, Veerle Cossey, Johannes B. van Goudoever, Christiaan V. Hulzebos, Peter Andriessen, Anton H. van Kaam, Boris W. Kramer, Richard A. van Lingen, Daniel C. Vijlbrief, Mirjam M. van Weissenbruch, Marc Benninga, Nanne K. H. de Boer, Tim G. J. de Meij

^*Corresponding author for this work

Research output: Contribution to journal › (Systematic) Review article › peer-review

Abstract

Background: The identification of independent clinical risk factors for necrotizing enterocolitis (NEC) may contribute to early selection of infants at risk, allowing for the development of targeted strategies aimed at the prevention of NEC. Objective: The objective of this study was to identify independent risk factors contributing to the development of NEC in a large multicenter cohort. Methods: This prospective cohort study was performed in 9 neonatal intensive care units. Infants born at a gestational age <= 30 weeks were included. Demographic and clinical data were collected daily until day 28 postnatally. Factors predictive of the development of NEC were identified using univariate and multivariable analyses in a 1:5 matched case-control cohort. Results: In total, 843 infants (56 NEC cases) were included in this study. In the case-control cohort, univariate analysis identified sepsis prior to the onset of NEC and formula feeding to be associated with an increased risk of developing NEC, whereas the administration of antibiotics directly postpartum was inversely associated with NEC. In a multivariable logistic regression model, enteral feeding type and the number of days parenterally fed remained statistically significantly associated with NEC, whereas the administration of antibiotics directly after birth was associated with a lower risk of developing NEC. Conclusions: Formula feeding and prolonged (duration of) parenteral feeding were associated with an increased risk of NEC. Contrary to expectations, the initiation of treatment with antibiotics within 24 h after birth was inversely associated with NEC. (C) 2018 The Author(s) Published by S. Karger AG, Basel

Original language	English
Pages (from-to)	277-284
Number of pages	8
Journal	Neonatology
Volume	114
Issue number	3
DOIs	https://doi.org/10.1159/000489677
Publication status	Published - 1 Jan 2018

Keywords

Neonatology
Sepsis
Formula feeding
Risk factors
Mortality
Antibiotics
BIRTH-WEIGHT INFANTS
ORGANIC-COMPOUNDS ANALYSIS
PRETERM INFANTS
ANTIBIOTIC-TREATMENT
SEPSIS
METAANALYSIS
TRANSFUSION
MICROBIOTA
MILK

Access to Document

10.1159/000489677Licence: CC BY-NC-ND

https://www.karger.com/Article/Pdf/489677

Cite this

Berkhout, D. J. C., Klaassen, P., Niemarkt, H. J., de Boode, W. P., Cossey, V., van Goudoever, J. B., Hulzebos, C. V., Andriessen, P., van Kaam, A. H., Kramer, B. W., van Lingen, R. A., Vijlbrief, D. C., van Weissenbruch, M. M., Benninga, M., de Boer, N. K. H., & de Meij, T. G. J. (2018). Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study. Neonatology, 114(3), 277-284. https://doi.org/10.1159/000489677

@article{7a4315458e3942c5a249afca7c8db312,

title = "Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study",

abstract = "Background: The identification of independent clinical risk factors for necrotizing enterocolitis (NEC) may contribute to early selection of infants at risk, allowing for the development of targeted strategies aimed at the prevention of NEC. Objective: The objective of this study was to identify independent risk factors contributing to the development of NEC in a large multicenter cohort. Methods: This prospective cohort study was performed in 9 neonatal intensive care units. Infants born at a gestational age <= 30 weeks were included. Demographic and clinical data were collected daily until day 28 postnatally. Factors predictive of the development of NEC were identified using univariate and multivariable analyses in a 1:5 matched case-control cohort. Results: In total, 843 infants (56 NEC cases) were included in this study. In the case-control cohort, univariate analysis identified sepsis prior to the onset of NEC and formula feeding to be associated with an increased risk of developing NEC, whereas the administration of antibiotics directly postpartum was inversely associated with NEC. In a multivariable logistic regression model, enteral feeding type and the number of days parenterally fed remained statistically significantly associated with NEC, whereas the administration of antibiotics directly after birth was associated with a lower risk of developing NEC. Conclusions: Formula feeding and prolonged (duration of) parenteral feeding were associated with an increased risk of NEC. Contrary to expectations, the initiation of treatment with antibiotics within 24 h after birth was inversely associated with NEC. (C) 2018 The Author(s) Published by S. Karger AG, Basel",

keywords = "Neonatology, Sepsis, Formula feeding, Risk factors, Mortality, Antibiotics, BIRTH-WEIGHT INFANTS, ORGANIC-COMPOUNDS ANALYSIS, PRETERM INFANTS, ANTIBIOTIC-TREATMENT, SEPSIS, METAANALYSIS, TRANSFUSION, MICROBIOTA, MILK",

author = "Berkhout, {Daniel J. C.} and Patrick Klaassen and Niemarkt, {Hendrik J.} and {de Boode}, {Willem P.} and Veerle Cossey and {van Goudoever}, {Johannes B.} and Hulzebos, {Christiaan V.} and Peter Andriessen and {van Kaam}, {Anton H.} and Kramer, {Boris W.} and {van Lingen}, {Richard A.} and Vijlbrief, {Daniel C.} and {van Weissenbruch}, {Mirjam M.} and Marc Benninga and {de Boer}, {Nanne K. H.} and {de Meij}, {Tim G. J.}",

year = "2018",

month = jan,

day = "1",

doi = "10.1159/000489677",

language = "English",

volume = "114",

pages = "277--284",

journal = "Neonatology",

issn = "1661-7800",

publisher = "Karger",

number = "3",

}

Berkhout, DJC, Klaassen, P, Niemarkt, HJ, de Boode, WP, Cossey, V, van Goudoever, JB, Hulzebos, CV, Andriessen, P, van Kaam, AH, Kramer, BW, van Lingen, RA, Vijlbrief, DC, van Weissenbruch, MM, Benninga, M, de Boer, NKH & de Meij, TGJ 2018, 'Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study', Neonatology, vol. 114, no. 3, pp. 277-284. https://doi.org/10.1159/000489677

TY - JOUR

T1 - Risk Factors for Necrotizing Enterocolitis

T2 - A Prospective Multicenter Case-Control Study

AU - Berkhout, Daniel J. C.

AU - Klaassen, Patrick

AU - Niemarkt, Hendrik J.

AU - de Boode, Willem P.

AU - Cossey, Veerle

AU - van Goudoever, Johannes B.

AU - Hulzebos, Christiaan V.

AU - Andriessen, Peter

AU - van Kaam, Anton H.

AU - Kramer, Boris W.

AU - van Lingen, Richard A.

AU - Vijlbrief, Daniel C.

AU - van Weissenbruch, Mirjam M.

AU - Benninga, Marc

AU - de Boer, Nanne K. H.

AU - de Meij, Tim G. J.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: The identification of independent clinical risk factors for necrotizing enterocolitis (NEC) may contribute to early selection of infants at risk, allowing for the development of targeted strategies aimed at the prevention of NEC. Objective: The objective of this study was to identify independent risk factors contributing to the development of NEC in a large multicenter cohort. Methods: This prospective cohort study was performed in 9 neonatal intensive care units. Infants born at a gestational age <= 30 weeks were included. Demographic and clinical data were collected daily until day 28 postnatally. Factors predictive of the development of NEC were identified using univariate and multivariable analyses in a 1:5 matched case-control cohort. Results: In total, 843 infants (56 NEC cases) were included in this study. In the case-control cohort, univariate analysis identified sepsis prior to the onset of NEC and formula feeding to be associated with an increased risk of developing NEC, whereas the administration of antibiotics directly postpartum was inversely associated with NEC. In a multivariable logistic regression model, enteral feeding type and the number of days parenterally fed remained statistically significantly associated with NEC, whereas the administration of antibiotics directly after birth was associated with a lower risk of developing NEC. Conclusions: Formula feeding and prolonged (duration of) parenteral feeding were associated with an increased risk of NEC. Contrary to expectations, the initiation of treatment with antibiotics within 24 h after birth was inversely associated with NEC. (C) 2018 The Author(s) Published by S. Karger AG, Basel

AB - Background: The identification of independent clinical risk factors for necrotizing enterocolitis (NEC) may contribute to early selection of infants at risk, allowing for the development of targeted strategies aimed at the prevention of NEC. Objective: The objective of this study was to identify independent risk factors contributing to the development of NEC in a large multicenter cohort. Methods: This prospective cohort study was performed in 9 neonatal intensive care units. Infants born at a gestational age <= 30 weeks were included. Demographic and clinical data were collected daily until day 28 postnatally. Factors predictive of the development of NEC were identified using univariate and multivariable analyses in a 1:5 matched case-control cohort. Results: In total, 843 infants (56 NEC cases) were included in this study. In the case-control cohort, univariate analysis identified sepsis prior to the onset of NEC and formula feeding to be associated with an increased risk of developing NEC, whereas the administration of antibiotics directly postpartum was inversely associated with NEC. In a multivariable logistic regression model, enteral feeding type and the number of days parenterally fed remained statistically significantly associated with NEC, whereas the administration of antibiotics directly after birth was associated with a lower risk of developing NEC. Conclusions: Formula feeding and prolonged (duration of) parenteral feeding were associated with an increased risk of NEC. Contrary to expectations, the initiation of treatment with antibiotics within 24 h after birth was inversely associated with NEC. (C) 2018 The Author(s) Published by S. Karger AG, Basel

KW - Neonatology

KW - Sepsis

KW - Formula feeding

KW - Risk factors

KW - Mortality

KW - Antibiotics

KW - BIRTH-WEIGHT INFANTS

KW - ORGANIC-COMPOUNDS ANALYSIS

KW - PRETERM INFANTS

KW - ANTIBIOTIC-TREATMENT

KW - SEPSIS

KW - METAANALYSIS

KW - TRANSFUSION

KW - MICROBIOTA

KW - MILK

U2 - 10.1159/000489677

DO - 10.1159/000489677

M3 - (Systematic) Review article

C2 - 29996136

SN - 1661-7800

VL - 114

SP - 277

EP - 284

JO - Neonatology

JF - Neonatology

IS - 3

ER -