FREQUENCY OF NECROTIZING ENTEROCOLITIS IN PRETERM NEONATES AND THEIR OUTCOME DURING HOSPITAL STAY

Background: Neonatal necrotizing enterocolitis [NEC], characterized by intestinal necrosis and pneumatosis intestinal, is the most common gastrointestinal emergency in the premature newborns[1] . The disease has an incidence rate of 2 to 5% in premature infants. The incidence rate increases to 13% in those weighing 1,500 gram at birth. NEC has a mortality rate of 10 to 55%. Objective: To determine the frequency of necrotizing enterocolitis in preterm neonates along with their outcome during stay in hospital. Methods: All premature newborn with morbidity admitted at Neonatal Intensive Care Unit [NICU] the Children Hospital, PIMS, Islamabad were screened for enrolment. A total of 156 premature newborn who fulfilled the inclusion criteria were enrolled in the current study. The duration of study was 6 months. At the time of enrolment, demographic characteristics of all the enrolled babies were obtained and noted on the proforma specially designed for the study. Delivery complications, enteral feeding status and resuscitation at birth were also noted. Each baby was assessed for the diagnosis of NEC. Those who were diagnosed to have NEC where then followed for outcome. The outcome of study was either discharged [n=35] or died [n=12] during the hospital stay. Results: During the study period a total of 156 babies were enrolled. Out of 156 babies, 47 [30.1%] babies were diagnosed to have NEC. The mean [SD] age of babies with NEC in this study was 7.8 [±4.1] days. Out of 47, 29 [62.0%] babies were aged up to 8 days. Out of 47 babies with NEC, 27 [57.0%] babies were male. Out of 47 babies with NEC, 26 [55.3%] babies were residence of urban areas. The mean [SD] gestational age was 32.1 [±3.4] weeks. Out of 47 babies with NEC, 30 [63.8%] babies with NEC had gestational age of 32 weeks or more. The mean [SD] weight was 1,813.7 [±283.4] grams. Out of 47 babies with NEC, 29 [61.7%] babies had weight less than 2,000 grams. Out of 47 babies with NEC, 28 [59.6%] babies with NEC were fed on formula milk. Out of 47 babies with NEC, 36 [76.6%] mothers had complications during the time of delivery. Out of 47 babies, 28 [60%] mothers had PROM. Out of 47 babies with NEC, 18 [38.3%] babies had hypoxic ischemic encephalopathy. Out of 47 babies with NEC, 28 [59.6%] babies with NEC were resuscitated at the time of birth. Out of 47 babies with NEC, 18 [38.3%] babies showed complete resolution, 11 [23.4%] babies showed partial resolution with residual disability, 6 [12.8%] babies with NEC showed no improvement whereas 12 [25.6%] babied died during their stay in the hospital. Conclusions: Our study shows that out of 156 babies admitted and enrolled in our study, 47 [30.1%] were diagnosed to have NEC. Out of these 47 babies with NEC, 35 [74.4%] survived with 18, 11 and 6 babies showed complete resolution, partial resolution with residual disability, and no improvement respectively, while 12 [25.6%] were died during their hospital stay. However, there is a need to conduct further research including a multi-centre, large sample size study to investigate the burden of NEC in Pakistan.