Is material human immunodeficiency virus positivity a risk factor for the development of necrotizing enterocolitis in premature infants
Ondongo-Ezhet, Claude Christelle Eleonore
Introduction Little is known about the association between maternal HIV status and the development of necrotizing enterocolitis (NEC) in premature infants. The few studies that have been published give no clear picture. In the light of the high maternal HIV infection in South Africa, it is important to explore the association between maternal HIV infection and all aspects of the paediatric population. Objectives The primary objective of this study was to determine if maternal HIV positive status was associated with the development of NEC in preterm infants who were born in one of our academic hospitals. The second objective was to determine the severity, need for surgery and mortality of preterm infants with NEC according to maternal HIV status. Finally, the third objective was to determine risk factors associated with NEC. Method The study population included preterm newborns less than 1500 grams born at the CMJAH and admitted to the neonatal unit within 24 hours of birth. Data on maternal and infant characteristics were collected from the computerized neonatal database from January 2006 to December 2013. Results A total of 2355 infants <1500g constituted the study population. Of these 126 met the inclusion criteria for NEC and 2229 did not. Therefore, large proportions were not entered for a multivariate analysis. Univariate analysis did not demonstrate an association between maternal HIV positive status and NEC (OR: 1.3, 95% CI: 0.8-1.9, p= 0.2). Therefore it was not entered into the multivariate analysis. On multivariate analysis antenatal corticosteroids showed a protective association with NEC (OR: 0.2, 95% CI: 0.1-0.4, p< 0.05). Multiple pregnancy and the need for resuscitation at birth was associated with NEC (OR: 1.6, 95% CI: 1-2.5, p= 0.03), (OR: 8, 95% CI: 4.5-15, p< 0.05), respectively. The analysis also found that severity of NEC, the need for surgery and mortality among infants with NEC did not differ according to maternal HIV status (p= 0.9, p=0.7 and p= 0.4), respectively. Conclusions The analysis was not able to demonstrate an association between maternal HIV positivity and the risk of NEC. Risk factors for NEC that were identified were multiple pregnancies and the need for resuscitation at birth. Antenatal corticosteroids were found to have a protective association with NEC. Finally, severity, need for surgery and mortality did not also differ according to maternal HIV status among the NEC group.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand. Johannesburg, 2015