Preventing severe necrotizing enterocolitis: Propensity score analysis of interventions associated with surgical NEC or NEC-associated death

Preventing severe necrotizing enterocolitis: Propensity score analysis of interventions associated with surgical NEC or NEC-associated death

To determine what modifiable interventions used in the neonatal intensive care unit (NICU) are associated with severe necrotizing enterocolitis (NEC) requiring surgical intervention. A retrospective review of patients treated for NEC at a tertiary hospital from 1991 to 2016 was performed. Patient ch...

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Bibliographic Details
Published in:Journal of pediatric surgery Vol. 58; no. 5; pp. 828 - 833
Main Authors: Cowap, Michael, Stepnuk, Danielle, Stockl, Christopher, Wolfe, Emma, Levesque, Matthew, Shawyer, Anna C., Balshaw, Rob, Lum Min, Suyin A., Keijzer, Richard
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-05-2023
Subjects:
Anti-Bacterial Agents - therapeutic use
Disease severity
Enterocolitis, Necrotizing - complications
Enterocolitis, Necrotizing - prevention & control
Enterocolitis, Necrotizing - surgery
Female
Humans
Infant, Newborn
Infant, Newborn, Diseases
Intensive Care Units, Neonatal
Necrotizing enterocolitis
NICU
Propensity Score
Retrospective Studies
Risk factors
Umbilical catheters
Disease severity
UVC
Umbilical catheters
UAC
NSAIDs
Necrotizing enterocolitis
NICU
NEC
Risk factors
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Summary:To determine what modifiable interventions used in the neonatal intensive care unit (NICU) are associated with severe necrotizing enterocolitis (NEC) requiring surgical intervention. A retrospective review of patients treated for NEC at a tertiary hospital from 1991 to 2016 was performed. Patient characteristics were used to calculate propensity scores for likelihood of exposure to seven interventions: enteral feeds, use of glucocorticoids, nonsteroidal anti-inflammatory drugs (NSAIDs), antacids, antibiotics, or umbilical arterial (UAC) and venous catheters (UVC). Conditional logistic regression was used to compare the odds of having surgical NEC if exposed to each treatment. We included 195 NEC patients: 69 severe NEC managed with surgery and 126 non-severe NEC managed medically. After propensity score matching based on birth characteristics, exposure to glucocorticoids (OR 5.21, 95%CI: 1.62, 16.70), NSAIDs (OR 4.87, 95%CI: 1.67, 14.17), UVC (OR 2.53 (95%CI: 1.19, 5.73), and UAC (OR 4.91, 95%CI: 2.12, 11.37) were associated with surgical NEC in separate conditional logistic regression analyses. Including these treatments in a second round of propensity matching and conditional logistic regression revealed that glucocorticoids (OR 2.99, 95%CI: 1.01, 8.88), NSAIDs (OR 3.97, 95%CI: 1.41, 11.19), UVC (OR 3.07, 95%CI: 1.46, 6.48), and UAC (OR 5.10, 95%CI: 2.10, 12.36) were still associated with surgical NEC. After controlling for birth confounders and common NICU supportive interventions, use of glucocorticoids, NSAIDs and umbilical catheters independently increased the odds of developing severe NEC requiring surgical intervention. Case-control, Level III evidence.
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content type line 23
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2023.01.023