Incidence of Necrotizing Enterocolitis and an Assessment of Related Risk Factors and Outcomes

Abstract

Necrotizing Enterocolitis (NEC), defined as inflammation of the intestines most commonly due to a bacterial cause, is a relatively rare condition widely encountered in premature infants. Established risk factors for developing NEC include low gestational age, extremely low birth weight, sepsis, and hypotension. However, studies have investigated other causes that may alter the gut microbiome, such as blood transfusions, antibiotic use, and co-morbid conditions. The study design is a retrospective cohort study, and patient data were collected from King Hamad University Hospital (KHUH) after receiving the necessary approvals. Patients included in this study were from 2012 to 2020. The variables assessed included gestational age, birth weight, hemoglobin and hematocrit levels, prenatal and postnatal antibiotic use, blood transfusions, other transfusion products the patients received, and blood culture results. A total of 16 patients were identified as having NEC after thoroughly reviewing their files, and the data were analyzed at the KHUH Research Department. Although a small sample size was involved in this study, antibiotic use was a significant factor in the development of NEC as antibiotics such as ampicillin, gentamicin, and cefotaxime have been shown to alter the gut microbiome, which can predispose a patient to the development of NEC, as was reflected in our study. We also observed a 10.4-time relative risk for developing NEC in patients who had received blood transfusions. The use of antibiotics in patients with NEC has been shown to increase the likelihood of developing the condition, especially with the predominance of Enterobacteriaceae. Although controversial, blood transfusions have also been associated with the development of NEC. Due to the fragile vascular system in patients with NEC, constant phlebotomies and the introduction of packed red blood cells can alter the levels of nitric oxide present, predisposing premature infants to hypoxic conditions and, therefore, the development of NEC.