Necrotizing enterocolitis in full-term infants. A case-control study
T. E. Wiswell, C. F. Robertson, T. A. Jones and D. J. Tuttle
Neonatology Services, Brooke Army Medical Center, San Antonio, Tex.
We performed a case-control investigation of 43 full-term infants with
necrotizing enterocolitis (NEC) to identify possible risk factors and
unique features of the disorder in the more mature infant. Two control
groups were used. The first consisted of "healthy" term infants. The second
was a group of "sick" term infants who did not develop NEC. The 43 term
infants with NEC represented 12.7% of all 338 neonates with NEC. The median
age at onset of symptoms was 2 days, and 18 infants developed NEC on the
first day of life. Two (4.7%) of the 43 affected term infants died, while
35 (11.9%) of 295 preterm infants with the disorder died. Only three of the
full-term infants who subsequently developed NEC had entirely unremarkable
courses prior to the onset of symptoms. Sick infants, in particular those
who are small for gestational age or require exchange transfusions, are at
risk for NEC. Several other features that may be associated with the
subsequent development of NEC include the following: perinatal asphyxia,
presence of umbilical catheters, antecedent respiratory distress,
polycythemia, and maternal preeclampsia. Full-term infants with these
features should be treated with cautious observation and aggressive
management early in the neonatal period should they develop signs and
symptoms suggestive of NEC.
