Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

Daniel J. C. Berkhout, Patrick Klaassen, Hendrik J. Niemarkt, Willem P. de Boode, Veerle Cossey, Johannes B. van Goudoever, Christiaan V. Hulzebos, Peter Andriessen, Anton H. van Kaam, Boris W. Kramer, Richard A. van Lingen, Daniel C. Vijlbrief, Mirjam M. van Weissenbruch, Marc Benninga, Nanne K. H. de Boer, Tim G. J. de Meij

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: The identification of independent clinical risk factors for necrotizing enterocolitis (NEC) may contribute to early selection of infants at risk, allowing for the development of targeted strategies aimed at the prevention of NEC. Objective: The objective of this study was to identify independent risk factors contributing to the development of NEC in a large multicenter cohort. Methods: This prospective cohort study was performed in 9 neonatal intensive care units. Infants born at a gestational age ≤30 weeks were included. Demographic and clinical data were collected daily until day 28 postnatally. Factors predictive of the development of NEC were identified using univariate and multivariable analyses in a 1: 5 matched case-control cohort. Results: In total, 843 infants (56 NEC cases) were included in this study. In the case-control cohort, univariate analysis identified sepsis prior to the onset of NEC and formula feeding to be associated with an increased risk of developing NEC, whereas the administration of antibiotics directly postpartum was inversely associated with NEC. In a multivariable logistic regression model, enteral feeding type and the number of days parenterally fed remained statistically significantly associated with NEC, whereas the administration of antibiotics directly after birth was associated with a lower risk of developing NEC. Conclusions: Formula feeding and prolonged (duration of) parenteral feeding were associated with an increased risk of NEC. Contrary to expectations, the initiation of treatment with antibiotics within 24 h after birth was inversely associated with NEC.
Original languageEnglish
Pages (from-to)277-284
JournalNeonatology
Volume114
Issue number3
DOIs
Publication statusPublished - 2018

Cite this

Berkhout, Daniel J. C. ; Klaassen, Patrick ; Niemarkt, Hendrik J. ; de Boode, Willem P. ; Cossey, Veerle ; van Goudoever, Johannes B. ; Hulzebos, Christiaan V. ; Andriessen, Peter ; van Kaam, Anton H. ; Kramer, Boris W. ; van Lingen, Richard A. ; Vijlbrief, Daniel C. ; van Weissenbruch, Mirjam M. ; Benninga, Marc ; de Boer, Nanne K. H. ; de Meij, Tim G. J. / Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study. In: Neonatology. 2018 ; Vol. 114, No. 3. pp. 277-284.
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title = "Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study",
abstract = "Background: The identification of independent clinical risk factors for necrotizing enterocolitis (NEC) may contribute to early selection of infants at risk, allowing for the development of targeted strategies aimed at the prevention of NEC. Objective: The objective of this study was to identify independent risk factors contributing to the development of NEC in a large multicenter cohort. Methods: This prospective cohort study was performed in 9 neonatal intensive care units. Infants born at a gestational age ≤30 weeks were included. Demographic and clinical data were collected daily until day 28 postnatally. Factors predictive of the development of NEC were identified using univariate and multivariable analyses in a 1: 5 matched case-control cohort. Results: In total, 843 infants (56 NEC cases) were included in this study. In the case-control cohort, univariate analysis identified sepsis prior to the onset of NEC and formula feeding to be associated with an increased risk of developing NEC, whereas the administration of antibiotics directly postpartum was inversely associated with NEC. In a multivariable logistic regression model, enteral feeding type and the number of days parenterally fed remained statistically significantly associated with NEC, whereas the administration of antibiotics directly after birth was associated with a lower risk of developing NEC. Conclusions: Formula feeding and prolonged (duration of) parenteral feeding were associated with an increased risk of NEC. Contrary to expectations, the initiation of treatment with antibiotics within 24 h after birth was inversely associated with NEC.",
author = "Berkhout, {Daniel J. C.} and Patrick Klaassen and Niemarkt, {Hendrik J.} and {de Boode}, {Willem P.} and Veerle Cossey and {van Goudoever}, {Johannes B.} and Hulzebos, {Christiaan V.} and Peter Andriessen and {van Kaam}, {Anton H.} and Kramer, {Boris W.} and {van Lingen}, {Richard A.} and Vijlbrief, {Daniel C.} and {van Weissenbruch}, {Mirjam M.} and Marc Benninga and {de Boer}, {Nanne K. H.} and {de Meij}, {Tim G. J.}",
year = "2018",
doi = "10.1159/000489677",
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Berkhout, DJC, Klaassen, P, Niemarkt, HJ, de Boode, WP, Cossey, V, van Goudoever, JB, Hulzebos, CV, Andriessen, P, van Kaam, AH, Kramer, BW, van Lingen, RA, Vijlbrief, DC, van Weissenbruch, MM, Benninga, M, de Boer, NKH & de Meij, TGJ 2018, 'Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study' Neonatology, vol. 114, no. 3, pp. 277-284. https://doi.org/10.1159/000489677

Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study. / Berkhout, Daniel J. C.; Klaassen, Patrick; Niemarkt, Hendrik J.; de Boode, Willem P.; Cossey, Veerle; van Goudoever, Johannes B.; Hulzebos, Christiaan V.; Andriessen, Peter; van Kaam, Anton H.; Kramer, Boris W.; van Lingen, Richard A.; Vijlbrief, Daniel C.; van Weissenbruch, Mirjam M.; Benninga, Marc; de Boer, Nanne K. H.; de Meij, Tim G. J.

In: Neonatology, Vol. 114, No. 3, 2018, p. 277-284.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

AU - Berkhout, Daniel J. C.

AU - Klaassen, Patrick

AU - Niemarkt, Hendrik J.

AU - de Boode, Willem P.

AU - Cossey, Veerle

AU - van Goudoever, Johannes B.

AU - Hulzebos, Christiaan V.

AU - Andriessen, Peter

AU - van Kaam, Anton H.

AU - Kramer, Boris W.

AU - van Lingen, Richard A.

AU - Vijlbrief, Daniel C.

AU - van Weissenbruch, Mirjam M.

AU - Benninga, Marc

AU - de Boer, Nanne K. H.

AU - de Meij, Tim G. J.

PY - 2018

Y1 - 2018

N2 - Background: The identification of independent clinical risk factors for necrotizing enterocolitis (NEC) may contribute to early selection of infants at risk, allowing for the development of targeted strategies aimed at the prevention of NEC. Objective: The objective of this study was to identify independent risk factors contributing to the development of NEC in a large multicenter cohort. Methods: This prospective cohort study was performed in 9 neonatal intensive care units. Infants born at a gestational age ≤30 weeks were included. Demographic and clinical data were collected daily until day 28 postnatally. Factors predictive of the development of NEC were identified using univariate and multivariable analyses in a 1: 5 matched case-control cohort. Results: In total, 843 infants (56 NEC cases) were included in this study. In the case-control cohort, univariate analysis identified sepsis prior to the onset of NEC and formula feeding to be associated with an increased risk of developing NEC, whereas the administration of antibiotics directly postpartum was inversely associated with NEC. In a multivariable logistic regression model, enteral feeding type and the number of days parenterally fed remained statistically significantly associated with NEC, whereas the administration of antibiotics directly after birth was associated with a lower risk of developing NEC. Conclusions: Formula feeding and prolonged (duration of) parenteral feeding were associated with an increased risk of NEC. Contrary to expectations, the initiation of treatment with antibiotics within 24 h after birth was inversely associated with NEC.

AB - Background: The identification of independent clinical risk factors for necrotizing enterocolitis (NEC) may contribute to early selection of infants at risk, allowing for the development of targeted strategies aimed at the prevention of NEC. Objective: The objective of this study was to identify independent risk factors contributing to the development of NEC in a large multicenter cohort. Methods: This prospective cohort study was performed in 9 neonatal intensive care units. Infants born at a gestational age ≤30 weeks were included. Demographic and clinical data were collected daily until day 28 postnatally. Factors predictive of the development of NEC were identified using univariate and multivariable analyses in a 1: 5 matched case-control cohort. Results: In total, 843 infants (56 NEC cases) were included in this study. In the case-control cohort, univariate analysis identified sepsis prior to the onset of NEC and formula feeding to be associated with an increased risk of developing NEC, whereas the administration of antibiotics directly postpartum was inversely associated with NEC. In a multivariable logistic regression model, enteral feeding type and the number of days parenterally fed remained statistically significantly associated with NEC, whereas the administration of antibiotics directly after birth was associated with a lower risk of developing NEC. Conclusions: Formula feeding and prolonged (duration of) parenteral feeding were associated with an increased risk of NEC. Contrary to expectations, the initiation of treatment with antibiotics within 24 h after birth was inversely associated with NEC.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/29996136

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