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

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

Am J Perinatol. 2023 Oct 27. doi: 10.1055/a-2183-5155. Online ahead of print.

Authors

Mariela Sánchez-Rosado^{1

2}, Jordan D Reis^{1

3}, Mambarambath A Jaleel¹, Kimberly Clipp⁴, Kate L M Mangona⁵, L Steven Brown⁴, David B Nelson⁶, Myra H Wyckoff¹, Diksha Verma^{7

8}, Isabelle Kiefaber⁷, Cheryl S Lair⁴, Sujir P Nayak¹, Patti J Burchfield¹, Anita Thomas¹, Luc P Brion¹

Affiliations

¹ Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
² Division of Neonatology, Joe DiMaggio Children's Hospital, Hollywood, Florida.
³ Department of Pediatrics, Baylor Scott and White, Dallas, Texas.
⁴ Department of Pediatrics, Parkland Health and Hospital System, Dallas, Texas.
⁵ Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.
⁶ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, and Parkland Health, Dallas, Texas.
⁷ University of Texas Southwestern Medical Center, Dallas, Texas.
⁸ Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas.

PMID: 37769697
DOI: 10.1055/a-2183-5155

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..