Necrotizing Enterocolitis in the Full Term Neonate

Infographic · Jun 2019 · 1 min read

In brief

Retrospective study comparing necrotizing enterocolitis in full-term versus preterm neonates over 10 years. Full-term infants with NEC had higher rates of congenital heart disease but lower disease severity and surgical intervention rates, suggesting distinct pathophysiology from preterm NEC.

17% of NEC cases occur in full-term infants, often associated with congenital heart disease requiring cardiac surgery (64% vs 8% in preterm)
Full-term NEC presents with less severe disease: only 18% require surgery vs 59% in preterm infants
Full-term infants have lower Bell stage 3 disease rates (43% vs 82%) and less need for vasopressor/ventilatory support
Clinical presentation and outcomes differ significantly between term and preterm NEC, suggesting distinct pathophysiology
Cardiac surgery is a major risk factor for NEC in term infants, warranting heightened surveillance post-operatively

Written by the GCMD Library team from the infographic.

Eight-panel grid layout on a teal background, each panel containing a white icon (heart, IV bag, bell, scale, scalpel, lungs, test tubes, calendar) with arrows indicating directional trends. Each panel presents a clinical parameter with comparative percentages or values. Citation and QR code appear at bottom with Journal of Pediatric Surgery branding.

Necrotizing enterocolitis (NEC) has been a long-recognized complication of prematurity, but there is a paucity of studies on term infants. We sought to characterize the clinical presentation and outcomes of full term (FT) infants with NEC and compare these to our experience with preterm (PT) neonates.

Methods

We conducted a chart review of infants admitted to the NICU at University of Michigan with a diagnosis of NEC for over a 10-year period with a Modified Bell stage of 2 or greater. We compared the outcomes and comorbidities of PT against those of FT, defined as gestational age at birth below and above 37 weeks, respectively.

Results

Out of 170 infants, 28(17%) were FT. FT neonates were more likely to have undergone cardiac surgery for a congenital defect, excluding PDA ligation (64% vs. 8%)*. When compared to FT infants, PT infants were more likely to require surgical intervention (18% vs. 59%)*, have Bell stage 3 disease (82% vs. 43%)*, require vasopressor support (21% vs. 42%)+, and require ventilatory support (43% vs 75%)*. *p<0.01,+p<0.05.

Conclusion

FT neonates present with different patterns of disease and have different outcomes, suggesting that this may be a different clinical entity than NEC in preterm infants.