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Clinical Predictors of Necrotizing Enterocolitis in Premature Infants

Gregory, Katherine E.

doi: 10.1097/01.NNR.0000313488.72035.a9

Background: Necrotizing enterocolitis (NEC) has emerged as the most common neonatal gastrointestinal emergency, is the most common cause of death in neonates undergoing surgery, and accounts for yearly additional hospital charges in excess of $6.5 million. Prematurity is the only common variable identified in case-controlled studies exploring this disease.

Objectives: To improve the understanding of the relationship between factors related to intestinal inflammation and ischemia and the enteral feeding regimen in the context of the premature gut, thereby identifying antecedents of NEC.

Methods: Data were collected from the medical records of 247 premature infants for this retrospective case-controlled study. Diagnosis of NEC, as defined by Bell Stages IIA-IIIB, was required for study group assignment (n = 84). Multivariate analysis techniques were used to predict the relationships between selected variables on the outcome of NEC.

Results: Premature infants were 13 times more likely to develop NEC if the infant required increased respiratory support to maintain oxygenation during the early neonatal period and 6.4 times more likely to develop NEC if the infant did not receive nutritionally fortified enteral feedings of breast milk. When both factors were present, the odds of NEC increased 28.6 times when compared with infants without these factors.

Discussion: The study findings extend knowledge of antecedents to NEC beyond prematurity, highlighting the role that respiratory support and nutritional fortification of enteral feedings play in the pathogenesis of this disease. Early identification of antecedents to NEC will improve critical care management of the neonate and, in turn, decrease the incidence of this devastating gastrointestinal disease. The study findings will guide further inquiry in neonatal nutrition, physiologic and metabolic functioning, and acute clinical management of the neonate.

Katherine E. Gregory, PhD, RN, is Assistant Professor, W. F. Connell School of Nursing, Boston College, Massachusetts.

Editor's Note Materials documenting the review process for this article are posted at

Accepted for publication January 30, 2008.

Funding for this study was provided by a university fellowship from Boston College and a Promise of Nursing Graduate Nursing Education Scholarship from Johnson & Johnson and the National League for Nursing Foundation.

Thank you to Dr. Barbara Hazard, dean and professor; Dr. Joyce Pulcini, associate professor; Dr. Catherine Read, associate professor; and all of the staff of the W. F. Connell School of Nursing, Boston College, for their oversight of this study. Thank you also to Dr. Ellen Mahoney, associate professor, and Dr. Angela Amar, assistant professor, for their thoughtful review of this manuscript.

Corresponding author: Katherine E. Gregory, PhD, RN, W. F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, Boston, MA 02467 (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.