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BMC Pediatrics
Published in: BMC Pediatrics 1/2017

Open Access 01-12-2017 | Research article

Risk factors for necrotizing enterocolitis in neonates: a systematic review of prognostic studies

Authors: Noor Samuels, Rob A. van de Graaf, Rogier C. J. de Jonge, Irwin K. M. Reiss, Marijn J. Vermeulen

Published in: BMC Pediatrics | Issue 1/2017

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Abstract

Background

Necrotizing 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.

Methods

Medline, 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).

Results

From 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.

Conclusion

High 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.
Appendix
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Literature
1.
2.
Thompson AM, Bizzarro MJ. Necrotizing enterocolitis in newborns: pathogenesis, prevention and management. Drugs. 2008;68(9):1227–38.CrossRefPubMed
3.
Patel RM, Kandefer S, Walsh MC, Bell EF, Carlo WA, Laptook AR, Sanchez PJ, Shankaran S, Van Meurs KP, Ball MB, et al. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med. 2015;372(4):331–40.CrossRefPubMedPubMedCentral
4.
5.
Schulzke SM, Deshpande GC, Patole SK. Neurodevelopmental outcomes of very low-birth-weight infants with necrotizing enterocolitis: a systematic review of observational studies. Arch Pediatr Adolesc Med. 2007;161(6):583–90.CrossRefPubMed
6.
AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev. 2014;4:CD005496.
7.
Bury RG, Tudehope D. Enteral antibiotics for preventing necrotizing enterocolitis in low birthweight or preterm infants. Cochrane Database Syst Rev. 2001;1:CD000405.
8.
Good M, Sodhi CP, Hackam DJ. Evidence-based feeding strategies before and after the development of necrotizing enterocolitis. Expert Rev Clin Immunol. 2014;10(7):875–84.CrossRefPubMedPubMedCentral
9.
Halac E, Halac J, Begue EF, Casanas JM, Indiveri DR, Petit JF, Figueroa MJ, Olmas JM, Rodriguez LA, Obregon RJ, et al. Prenatal and postnatal corticosteroid therapy to prevent neonatal necrotizing enterocolitis: a controlled trial. J Pediatr. 1990;117(1 Pt 1):132–8.CrossRefPubMed
10.
Deshpande G, Rao S, Patole S, Bulsara M. Updated meta-analysis of probiotics for preventing necrotizing enterocolitis in preterm neonates. Pediatrics. 2010;125(5):921–30.CrossRefPubMed
11.
Markel TA, Crisostomo PR, Wairiuko GM, Pitcher J, Tsai BM, Meldrum DR. Cytokines in necrotizing enterocolitis. Shock. 2006;25(4):329–37.CrossRefPubMed
12.
Moons KG, Royston P, Vergouwe Y, Grobbee DE, Altman DG. Prognosis and prognostic research: what, why, and how? BMJ. 2009;338:b375.CrossRefPubMed
13.
Hemingway H, Croft P, Perel P, Hayden JA, Abrams K, Timmis A, Briggs A, Udumyan R, Moons KG, Steyerberg EW, et al. Prognosis research strategy (PROGRESS) 1: a framework for researching clinical outcomes. BMJ. 2013;346:e5595.CrossRefPubMedPubMedCentral
14.
Riley RD, Hayden JA, Steyerberg EW, Moons KG, Abrams K, Kyzas PA, Malats N, Briggs A, Schroter S, Altman DG, et al. Prognosis Research Strategy (PROGRESS) 2: prognostic factor research. PLoS Med. 2013;10(2):e1001380.CrossRefPubMedPubMedCentral
15.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100.CrossRefPubMedPubMedCentral
16.
Hayden JA, van der Windt DA, Cartwright JL, Cote P, Bombardier C. Assessing bias in studies of prognostic factors. Ann Intern Med. 2013;158(4):280–6.CrossRefPubMed
17.
de Jonge RC, van Furth AM, Wassenaar M, Gemke RJ, Terwee CB. Predicting sequelae and death after bacterial meningitis in childhood: a systematic review of prognostic studies. BMC Infect Dis. 2010;10:232.CrossRefPubMedPubMedCentral
18.
Gephart SM, Spitzer AR, Effken JA, Dodd E, Halpern M, McGrath JM. Discrimination of GutCheck(NEC): a clinical risk index for necrotizing enterocolitis. J Perinatol. 2014;34(6):468–75.CrossRefPubMedPubMedCentral
19.
Clark RH, Gordon P, Walker WM, Laughon M, Smith PB, Spitzer AR. Characteristics of patients who die of necrotizing enterocolitis. J Perinatol. 2012;32(3):199–204.CrossRefPubMed
20.
Llanos AR, Moss ME, Pinzon MC, Dye T, Sinkin RA, Kendig JW. Epidemiology of neonatal necrotising enterocolitis: a population-based study. Paediatr Perinat Epidemiol. 2002;16(4):342–9.CrossRefPubMed
21.
Boo NY, Cheah IG. Risk factors associated with necrotising enterocolitis in very low birth weight infants in Malaysian neonatal intensive care units. Singap Med J. 2012;53(12):826–31.
22.
Carter BM, Holditch-Davis D. Risk factors for necrotizing enterocolitis in preterm infants: how race, gender, and health status contribute. Adv Neonatal Care. 2008;8(5):285–90.CrossRefPubMedPubMedCentral
23.
Guthrie SO, Gordon PV, Thomas V, Thorp JA, Peabody J, Clark RH. Necrotizing enterocolitis among neonates in the United States. J Perinatol. 2003;23(4):278–85.CrossRefPubMed
24.
Uauy RD, Fanaroff AA, Korones SB, Phillips EA, Phillips JB, Wright LL. Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical correlates. National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr. 1991;119(4):630–8.CrossRefPubMed
25.
Luig M, Lui K. Nsw, Group AN: Epidemiology of necrotizing enterocolitis--Part II: Risks and susceptibility of premature infants during the surfactant era: a regional study. J Paediatr Child Health. 2005;41(4):174–9.CrossRefPubMed
26.
Yamoto M, Nakazawa Y, Fukumoto K, Miyake H, Nakajima H, Sekioka A, Nomura A, Ooyama K, Yamada Y, Nogami K, et al. Risk factors and prevention for surgical intestinal disorders in extremely low birth weight infants. Pediatr Surg Int. 2016;32(9):887–93.CrossRefPubMed
27.
Yee WH, Soraisham AS, Shah VS, Aziz K, Yoon W, Lee SK, Canadian Neonatal N. Incidence and timing of presentation of necrotizing enterocolitis in preterm infants. Pediatrics. 2012;129(2):e298–304.CrossRefPubMed
28.
Gagliardi L, Bellu R, Cardilli V, De Curtis M, Network Neonatale L. Necrotising enterocolitis in very low birth weight infants in Italy: incidence and non-nutritional risk factors. J Pediatr Gastroenterol Nutr. 2008;47(2):206–10.CrossRefPubMed
29.
Kliegman RM, Hack M, Jones P, Fanaroff AA. Epidemiologic study of necrotizing enterocolitis among low-birth-weight infants. Absence of identifiable risk factors. J Pediatr. 1982;100(3):440–4.CrossRefPubMed
30.
31.
Been JV, Lievense S, Zimmermann LJ, Kramer BW, Wolfs TG. Chorioamnionitis as a risk factor for necrotizing enterocolitis: a systematic review and meta-analysis. J Pediatr. 2013;162(2):236–42. e232.CrossRefPubMed
32.
Holman RC, Stoll BJ, Curns AT, Yorita KL, Steiner CA, Schonberger LB. Necrotising enterocolitis hospitalisations among neonates in the United States. Paediatr Perinat Epidemiol. 2006;20(6):498–506.CrossRefPubMed
33.
Martinez-Tallo E, Claure N, Bancalari E. Necrotizing enterocolitis in full-term or near-term infants: risk factors. Biol Neonate. 1997;71(5):292–8.CrossRefPubMed
34.
Rand T, Weninger M, Kohlhauser C, Bischof S, Heinz-Peer G, Trattnig S, Popow C, Salzer HR. Effects of umbilical arterial catheterization on mesenteric hemodynamics. Pediatr Radiol. 1996;26(7):435–8.CrossRefPubMed
35.
Stout G, Lambert DK, Baer VL, Gordon PV, Henry E, Wiedmeier SE, Stoddard RA, Miner CA, Schmutz N, Burnett J, et al. Necrotizing enterocolitis during the first week of life: a multicentered case-control and cohort comparison study. J Perinatol. 2008;28(8):556–60.CrossRefPubMed
36.
Drenckpohl D, Knaub L, Schneider C. Risk factors that may predispose premature infants to increased incidence of necrotizing enterocolitis. ICAN: infant, Child, & Adolescent Nutrition 2010;2(1):37–44.
37.
Faustini A, Forastiere F, Giorgi Rossi P, Perucci CA. An epidemic of gastroenteritis and mild necrotizing enterocolitis in two neonatal units of a University Hospital in Rome. Italy Epidemiol Infect. 2004;132(3):455–65.CrossRefPubMed
38.
Lee JY, Park KH, Kim A, Yang HR, Jung EY, Cho SH. Maternal and Placental Risk Factors for Developing Necrotizing Enterocolitis in Very Preterm Infants. Pediatr. Neonatol 2016;58(1):57–62.
39.
Manogura AC, Turan O, Kush ML, Berg C, Bhide A, Turan S, Moyano D, Bower S, Nicolaides KH, Galan HL, et al. Predictors of necrotizing enterocolitis in preterm growth-restricted neonates. Am J Obstet Gynecol. 2008;198(6):638 e631–5.CrossRef
40.
Patel RM, Knezevic A, Shenvi N, Hinkes M, Keene S, Roback JD, Easley KA, Josephson CD. Association of Red Blood Cell Transfusion, Anemia, and Necrotizing Enterocolitis in Very Low-Birth-Weight Infants. JAMA. 2016;315(9):889–97.CrossRefPubMedPubMedCentral
41.
Tripepi G, Jager KJ, Dekker FW, Zoccali C. Testing for causality and prognosis: etiological and prognostic models. Kidney Int. 2008;74(12):1512–5.CrossRefPubMed
42.
Dretzke J, Ensor J, Bayliss S, Hodgkinson J, Lordkipanidze M, Riley RD, Fitzmaurice D, Moore D. Methodological issues and recommendations for systematic reviews of prognostic studies: an example from cardiovascular disease. Syst Rev. 2014;3:140.CrossRefPubMedPubMedCentral
43.
Cetinkaya M, Ozkan H, Koksal N. Maternal preeclampsia is associated with increased risk of necrotizing enterocolitis in preterm infants. Early Hum Dev. 2012;88(11):893–8.CrossRefPubMed
44.
Downard CD, Grant SN, Maki AC, Krupski MC, Matheson PJ, Bendon RW, Fallat ME, Garrison RN. Maternal cigarette smoking and the development of necrotizing enterocolitis. Pediatrics. 2012;130(1):78–82.CrossRefPubMed
45.
Garcia-Munoz Rodrigo F, Galan Henriquez G, Figueras Aloy J, Garcia-Alix Perez A. Outcomes of very-low-birth-weight infants exposed to maternal clinical chorioamnionitis: a multicentre study. Neonatology. 2014;106(3):229–34.CrossRefPubMed
46.
Weintraub AS, Ferrara L, Deluca L, Moshier E, Green RS, Oakman E, Lee MJ, Rand L. Antenatal antibiotic exposure in preterm infants with necrotizing enterocolitis. J Perinatol. 2012;32(9):705–9.CrossRefPubMed
47.
Wong D, Abdel-Latif M, Kent A, Network N. Antenatal steroid exposure and outcomes of very premature infants: a regional cohort study. Arch Dis Child Fetal Neonatal Ed. 2014;99(1):F12–20.CrossRefPubMed
48.
Grandi C, Tapia JL, Cardoso VC. Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants: a multicenter Latin America study. J Pediatr. 2015;91(3):234–41.CrossRef
Metadata
Title
Risk factors for necrotizing enterocolitis in neonates: a systematic review of prognostic studies
Authors
Noor Samuels
Rob A. van de Graaf
Rogier C. J. de Jonge
Irwin K. M. Reiss
Marijn J. Vermeulen
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2017
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-017-0847-3

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