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Neonatal Necrotizing Enterocolitis: A Nine-Year Experience: I. Epidemiology and Uncommon Observations

Neonatal Necrotizing Enterocolitis: A Nine-Year Experience: I. Epidemiology and Uncommon... Abstract • To gain an epidemiologic perspective on necrotizing enterocolitis (NEC), nine years' experience with 123 patients was reviewed. Mean gestational age was 31 weeks, and mean birth weight, 1,460 g; 7.3% were full-term and 10.5% were small for gestational age. Eighty infants had umbilical artery catheters, of which 50% were placed below L4-5. There was no identifiable risk factor in 11.4%; in half of these infants, NEC developed during an epidemic. Clustering of cases occurred in seven of the 108 months studied. Cases during epidemics had a lower incidence of respiratory distress syndrome. Average age at onset of NEC was 12 days; however the most common age (mode) was 3 days, and in 13.8% onset was after the third week. Of the survivors, 4% had recurrent disease one to 20 days after reinitiation of enteric feeding. The occurrence of NEC in low-risk patients and in older neonates raises serious questions about the proposed pathogenesis of NEC. (Am J Dis Child 1981;135:603-607) References 1. Kliegman RM, Pittard WB, Fanaroff AA: Necrotizing enterocolitis in neonates fed human milk . J Pediatr 1979;95:450-453.Crossref 2. Hack M, DeMonterice D, Jones P, et al: Rehospitalization of the very low birthweight (VLBW) infant: A continuum of perinatal morbidity, abstracted . Pediatr Res 1979;13:389. 3. Santulli TV, Schullinger JN, Heird WC, et al: Acute necrotizing enterocolitis in infancy: A review of 64 cases . Pediatrics 1975;55:376-387. 4. Bunton GL, Durbin GM, McIntosh N, et al: Necrotizing enterocolitis: Controlled study of three years' experience in a neonatal intensive care unit . Arch Dis Child 1977;52:772-777.Crossref 5. Hakanson DO, Oh W: Necrotizing enterocolitis and hyperviscosity in the newborn infant . J Pediatr 1977;90:458-461.Crossref 6. Leake RD, Thanopoulos B, Nieberg R: Hyperviscosity syndrome associated with necrotizing enterocolitis . Am J Dis Child 1975; 129:1192-1194. 7. Frantz ID, L'Heureux P, Engel RR, et al: Necrotizing enterocolitis . J Pediatr 1975;86:259-263.Crossref 8. Hopkins GB, Gould VE, Stevenson JK, et al: Necrotizing enterocolitis in premature infants . Am J Dis Child 1970;120:229-232.Crossref 9. Touloukian RJ, Posch JN, Spencer R: The pathogenesis of ischemic gastroenterocolitis of the neonate: Selective gut mucosal ischemia in asphyxiated neonatal piglets . J Pediatr Surg 1972;7:194-205.Crossref 10. Barlow B, Santulli TV, Heird WC, et al: An experimental study of acute neonatal enterocolitis: The importance of breast milk . J Pediatr Surg 1974;9:587-595.Crossref 11. Book LS, Overall JC Jr, Herbst JJ, et al: Clustering of necrotizing enterocolitis: Interruption by infection-control measures . N Engl J Med 1977;297:984-986.Crossref 12. Hill RR, Hunt CE, Matsen JM: Nosocomial colonization with Klebsiella, type 26, in a neonatal intensive-care unit associated with an outbreak of sepsis, meningitis, and necrotizing enterocolitis . J Pediatr 1974;85:415-419.Crossref 13. Howard RM, Flynn DM, Bradley JM, et al: Outbreak of necrotizing enterocolitis caused by Clostridium butyricum . Lancet 1977;2:1099-1102.Crossref 14. Stein H, Beck J, Solomon A, et al: Gastroenteritis with necrotizing enterocolitis in premature babies . Br Med J 1972;2:616-619.Crossref 15. Kitterman JA, Phibbs RH, Tooley W: Aortic blood pressure in normal newborn infants during the first 12 hours of life . Pediatrics 1969;44:959-968. 16. Egan EA, Mantilla G, Nelson RN, et al: A prospective controlled trial of oral kanamycin in the prevention of neonatal necrotizing enterocolitis . J Pediatr 1976;89:467-470.Crossref 17. Brown EG, Sweet AY: Preventing necrotizing enterocolitis in neonates . JAMA 1978; 240:2452-2454.Crossref 18. Mizrahi A, Barlow O, Berdon W, et al: Necrotizing enterocolitis in premature infants . J Pediatr 1965;66:697-706.Crossref 19. Book S, Herbert JJ, Jung AL: Necrotizing enterocolitis in infants fed an elemental formula . Pediatr Res 1974;8:379.Crossref 20. Hack M, Fanaroff AA, Merkatz I: The low birth weight infant: Evolution of a changing outlook . N Engl J Med 1979;301:1162-1166.Crossref 21. Roback SA, Foker J, Frantz IF, et al: Necrotizing enterocolitis . Arch Surg 1974; 109:314-319.Crossref 22. Yu VYH, Tudehope DI: Neonatal necrotizing enterocolitis: Two perinatal risk factors . Med J Aust 1977;1:688-693. 23. Kliegman RM: Neonatal necrotizing enterocolitis: Implications for an infectious disease . Pediatr Clin North Am 1979;26:327-344. 24. O'Neill JA Jr, Stahlman MT, Meng HC: Necrotizing enterocolitis in the newborn: Operative indications . Ann Surg 1975;182:274-279.Crossref 25. Polin RA, Pollack PF, Barlow B, et al: Necrotizing enterocolitis in term infants . J Pediatr 1976;89:460-462.Crossref 26. Shapiro AJ, Kavey RE, Dangman BC, et al: Necrotizing enterocolitis syndrome in symptomatic infants with congenital heart disease, abstracted . Pediatr Res 1977;11:541. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Neonatal Necrotizing Enterocolitis: A Nine-Year Experience: I. Epidemiology and Uncommon Observations

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References (30)

Publisher
American Medical Association
Copyright
Copyright © 1981 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1981.02130310009005
Publisher site
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Abstract

Abstract • To gain an epidemiologic perspective on necrotizing enterocolitis (NEC), nine years' experience with 123 patients was reviewed. Mean gestational age was 31 weeks, and mean birth weight, 1,460 g; 7.3% were full-term and 10.5% were small for gestational age. Eighty infants had umbilical artery catheters, of which 50% were placed below L4-5. There was no identifiable risk factor in 11.4%; in half of these infants, NEC developed during an epidemic. Clustering of cases occurred in seven of the 108 months studied. Cases during epidemics had a lower incidence of respiratory distress syndrome. Average age at onset of NEC was 12 days; however the most common age (mode) was 3 days, and in 13.8% onset was after the third week. Of the survivors, 4% had recurrent disease one to 20 days after reinitiation of enteric feeding. The occurrence of NEC in low-risk patients and in older neonates raises serious questions about the proposed pathogenesis of NEC. (Am J Dis Child 1981;135:603-607) References 1. Kliegman RM, Pittard WB, Fanaroff AA: Necrotizing enterocolitis in neonates fed human milk . J Pediatr 1979;95:450-453.Crossref 2. Hack M, DeMonterice D, Jones P, et al: Rehospitalization of the very low birthweight (VLBW) infant: A continuum of perinatal morbidity, abstracted . Pediatr Res 1979;13:389. 3. Santulli TV, Schullinger JN, Heird WC, et al: Acute necrotizing enterocolitis in infancy: A review of 64 cases . Pediatrics 1975;55:376-387. 4. Bunton GL, Durbin GM, McIntosh N, et al: Necrotizing enterocolitis: Controlled study of three years' experience in a neonatal intensive care unit . Arch Dis Child 1977;52:772-777.Crossref 5. Hakanson DO, Oh W: Necrotizing enterocolitis and hyperviscosity in the newborn infant . J Pediatr 1977;90:458-461.Crossref 6. Leake RD, Thanopoulos B, Nieberg R: Hyperviscosity syndrome associated with necrotizing enterocolitis . Am J Dis Child 1975; 129:1192-1194. 7. Frantz ID, L'Heureux P, Engel RR, et al: Necrotizing enterocolitis . J Pediatr 1975;86:259-263.Crossref 8. Hopkins GB, Gould VE, Stevenson JK, et al: Necrotizing enterocolitis in premature infants . Am J Dis Child 1970;120:229-232.Crossref 9. Touloukian RJ, Posch JN, Spencer R: The pathogenesis of ischemic gastroenterocolitis of the neonate: Selective gut mucosal ischemia in asphyxiated neonatal piglets . J Pediatr Surg 1972;7:194-205.Crossref 10. Barlow B, Santulli TV, Heird WC, et al: An experimental study of acute neonatal enterocolitis: The importance of breast milk . J Pediatr Surg 1974;9:587-595.Crossref 11. Book LS, Overall JC Jr, Herbst JJ, et al: Clustering of necrotizing enterocolitis: Interruption by infection-control measures . N Engl J Med 1977;297:984-986.Crossref 12. Hill RR, Hunt CE, Matsen JM: Nosocomial colonization with Klebsiella, type 26, in a neonatal intensive-care unit associated with an outbreak of sepsis, meningitis, and necrotizing enterocolitis . J Pediatr 1974;85:415-419.Crossref 13. Howard RM, Flynn DM, Bradley JM, et al: Outbreak of necrotizing enterocolitis caused by Clostridium butyricum . Lancet 1977;2:1099-1102.Crossref 14. Stein H, Beck J, Solomon A, et al: Gastroenteritis with necrotizing enterocolitis in premature babies . Br Med J 1972;2:616-619.Crossref 15. Kitterman JA, Phibbs RH, Tooley W: Aortic blood pressure in normal newborn infants during the first 12 hours of life . Pediatrics 1969;44:959-968. 16. Egan EA, Mantilla G, Nelson RN, et al: A prospective controlled trial of oral kanamycin in the prevention of neonatal necrotizing enterocolitis . J Pediatr 1976;89:467-470.Crossref 17. Brown EG, Sweet AY: Preventing necrotizing enterocolitis in neonates . JAMA 1978; 240:2452-2454.Crossref 18. Mizrahi A, Barlow O, Berdon W, et al: Necrotizing enterocolitis in premature infants . J Pediatr 1965;66:697-706.Crossref 19. Book S, Herbert JJ, Jung AL: Necrotizing enterocolitis in infants fed an elemental formula . Pediatr Res 1974;8:379.Crossref 20. Hack M, Fanaroff AA, Merkatz I: The low birth weight infant: Evolution of a changing outlook . N Engl J Med 1979;301:1162-1166.Crossref 21. Roback SA, Foker J, Frantz IF, et al: Necrotizing enterocolitis . Arch Surg 1974; 109:314-319.Crossref 22. Yu VYH, Tudehope DI: Neonatal necrotizing enterocolitis: Two perinatal risk factors . Med J Aust 1977;1:688-693. 23. Kliegman RM: Neonatal necrotizing enterocolitis: Implications for an infectious disease . Pediatr Clin North Am 1979;26:327-344. 24. O'Neill JA Jr, Stahlman MT, Meng HC: Necrotizing enterocolitis in the newborn: Operative indications . Ann Surg 1975;182:274-279.Crossref 25. Polin RA, Pollack PF, Barlow B, et al: Necrotizing enterocolitis in term infants . J Pediatr 1976;89:460-462.Crossref 26. Shapiro AJ, Kavey RE, Dangman BC, et al: Necrotizing enterocolitis syndrome in symptomatic infants with congenital heart disease, abstracted . Pediatr Res 1977;11:541.

Journal

American Journal of Diseases of Children – American Medical Association

Published: Jul 1, 1981

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