Impact of Size for Gestational Age on Multivariate Analysis of Factors Associated with Necrotizing Enterocolitis in Preterm Infants: Retrospective Cohort Study

Mariela Sánchez-Rosado; Jordan D. Reis; Mambarambath A. Jaleel; Kimberly Clipp; Kate L.M. Mangona; L Steven Brown; David B. Nelson; Myra H. Wyckoff; Diksha Verma; Isabelle Kiefaber; Cheryl S. Lair; Sujir P. Nayak; Patti J. Burchfield; Anita Thomas; Luc P. Brion

doi:10.1055/a-2183-5155

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(11): 1544-1553
DOI: 10.1055/a-2183-5155

Original Article

Impact of Size for Gestational Age on Multivariate Analysis of Factors Associated with Necrotizing Enterocolitis in Preterm Infants: Retrospective Cohort Study

Authors

Mariela Sánchez-Rosado

¹Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas

²Division of Neonatology, Joe DiMaggio Children's Hospital, Hollywood, Florida
Jordan D. Reis

¹Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas

³Department of Pediatrics, Baylor Scott and White, Dallas, Texas
Mambarambath A. Jaleel

¹Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
Kimberly Clipp

⁴Department of Pediatrics, Parkland Health and Hospital System, Dallas, Texas
Kate L.M. Mangona

⁵Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
L Steven Brown

⁴Department of Pediatrics, Parkland Health and Hospital System, Dallas, Texas
David B. Nelson

⁶Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, and Parkland Health, Dallas, Texas
Myra H. Wyckoff

¹Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
Diksha Verma

⁷University of Texas Southwestern Medical Center, Dallas, Texas

⁸Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas
Isabelle Kiefaber

⁷University of Texas Southwestern Medical Center, Dallas, Texas
Cheryl S. Lair

⁴Department of Pediatrics, Parkland Health and Hospital System, Dallas, Texas
Sujir P. Nayak

¹Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
Patti J. Burchfield

¹Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
Anita Thomas

¹Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
Luc P. Brion

¹Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas

Abstract

Objective Necrotizing enterocolitis (NEC) primarily affects preterm, especially small for gestational age (SGA), infants. This study was designed to (1) describe frequency and timing of NEC in SGA versus non-SGA infants and (2) assess whether NEC is independently associated with the severity of intrauterine growth failure.

Study Design Retrospective cohort study of infants without severe congenital malformations born <33 weeks' gestational age (GA) carried out from 2009 to 2021. The frequency and time of NEC were compared between SGA and non-SGA infants. Multivariate logistic regression was used to assess whether NEC was independently associated with intrauterine growth restriction. Severe growth restriction was defined as birth weight Z-score < −2.

Results Among 2,940 infants, the frequency of NEC was higher in SGA than in non-SGA infants (25/268 [9.3%] vs. 110/2,672 [4.1%], respectively, p < 0.001). NEC developed 2 weeks later in SGA than non-SGA infants. In multivariate analysis, the adjusted odds of NEC increased with extreme prematurity (<28 weeks' GA) and with severe but not moderate growth restriction. The adjusted odds of NEC increased with urinary tract infection or sepsis within a week prior to NEC, were lower in infants fed their mother's own milk until discharge, and did not change over five epochs. NEC was independently associated with antenatal steroid (ANS) exposure in infants with birth weight (BW) Z-score < 0.

Conclusion NEC was more frequent in SGA than in non-SGA infants and developed 2 weeks later in SGA infants. NEC was independently associated with severe intrauterine growth failure and with ANS exposure in infants with BW Z-score < 0.

Key Points

We studied 2,940 infants <33 weeks' GA.
We assessed NEC.
NEC was more frequent in SGA infants.
NEC occurred 2 weeks later in SGA infants.
NEC was associated with severe growth restriction.

Keywords

necrotizing enterocolitis - intrauterine growth failure - small for gestational age - preterm

Full Text

References

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