Necrotising enterocolitis in the Bloemfontein academic complex
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Date
2020-06
Authors
Osman, Tabassum
Journal Title
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Publisher
University of the Free State
Abstract
Background: Necrotising enterocolitis (NEC) is a serious acquired gastrointestinal emergency affecting predominantly premature neonates, especially those with a birthweight of <1500g. Despite advances in neonatal care, the condition still accounts for a high mortality and morbidity. In a resource limited setting, the disease may be more devastating. While other centres in South Africa have reported on the epidemiology, risk factors and outcomes of neonates with NEC, there are no comparable studies to date in the Free State Province. This study aims to lessen this gap. Objectives: The primary objective was to describe the prevalence and short-term outcomes of infants with NEC in terms of death, discharge or transfer. Secondarily it aimed to describe the presence of known risk factors and the course of illness and to compare all the above parameters between the weight categories - < 1000g, 1001g to 1499g and 1500g to 2000g. Methodology: This was a retrospective, descriptive cross-sectional study of infants with a birth weight of ≤2000g. There were 184 participants that were included in the study. Medical records and discharge summaries were used to extract relevant data. Descriptive statistics for categorical data and medians and percentiles for numerical data were calculated, per group. The groups were compared by means of Kruskal-Wallis test for numerical data and Chi-square or Fisher’s exact test for categorical data. The prevalence was calculated and described by means of 95% confidence interval for the prevalence. Results: There were 2574 neonatal discharge summaries of babies born with a weight ≤2000g that was screened and after exclusion criteria was applied, 184 neonates with confirmed NEC were identified. The prevalence of NEC was 7.1% [6.2%; 8.2%]. The distribution of cases according to weight were 47 in < 1000g, 101 in 1001 to 1499g and 36 in > 1500g categories. Fifty-six infants (30.4%) died [23 (41.1%) were < 1000g, 28 (50%) were 1001g to 1499g and 5 (8.9%) were >1500g], 106 (57.6%) were discharged and 22 (12%) were transferred to their base hospital. Mortality rates were higher in NEC grade 3A [11 (19.7%), RR 3.22 (95% CL 2.23 ; 4.52), P<. 001] and NEC grade 3B [ 28 (50%), RR 3.09 (95% CL 2.07 ; 4.61), P< .001]. Significant risk factors per weight category were maternal pre-eclampsia, RDS, mechanical ventilation and blood transfusion. Conclusion: NEC remains a formidable challenge to clinicians caring for neonates with prevalence and mortality rates comparable to other tertiary neonatal units.
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Keywords
Dissertation (M. Med. (Paediatrics and Child Health))--University of the Free State, 2020, Necrotising enterocolitis, Premature infant, Prematurity Low birth weight, Very low birth weight, Medical NEC, Surgical NEC