Factors associated with necrotizing enterocolitis in a public hospital in Johannesburg, South Africa, 2013 – 2018: a cross sectional study

Abstract

Background: Necrotizing Enterocolitis (NEC) is a devastating gastrointestinal disease that usually affects newborns. NEC is an important cause of neonatal1 deaths in the neonatal intensive care unit. This condition is more predominant in babies with a smaller gestational age. The purpose of this study was to determine the factors associated with necrotizing enterocolitis among the very low birth weight (VLBW; weight <1,500g) neonates in Charlotte Maxeke Johannesburg Academic hospital. Methods: Data was extracted from the VLBW standard database used for registering all VLBW neonates who are born and/or admitted within the first 28 days (neonatal period) of life. The study included all VLBW neonates born or admitted to the neonatal unit at (CMJAH) between 1st January, 2013 and 31st December, 2018. Data analysis was conducted using statistical software for data management and analysis (STATA 15.0). A diagnosis of NEC was established based on the clinical and radiological evidence of stage II or III, with respect to the Bell‟s criteria. Logistic regression analysis was performed to determine the significant risk factors associated with NEC.Results: The majority of the sample population was males (53%).Two hundred and forty-six (10.58%) infants developed NEC, out of which 83 (33.74%) neonates died. Over the six year period, there was a 7.4% Annual Percent Change (APC) and the overall prevalence of NEC almost doubled between 2016 (8.06%) and 2018 (15.24%). The prevalence of NEC was highest in 2018 (15.24). Results from the bivariate analysis showed that conventional ventilation (OR 7.962, 95% CI 5.944 – 10.665; P < 0.0001), neonates that were given oxygen on day 36 (OR 2.799, 95% CI 2.005 - 3.907; P < 0.0001), increasing maternal age (OR 1.026, 95% CI 1.003 - 1.051; P < 0.03), patent ductus arteriosus (OR 2.119, 95% CI 1.511 - 2.970; P < 0.0001), blood transfusion (OR 3.918, 95% CI 2.890 - 5.312; P < 0.0001), and respiratory distress syndrome (OR 1.802, 95% CI 1.121 - 2.896; P < 0.015) were significant risk factors for developing NEC.Furthermore, after controlling for potential confounders, Multivariable logistic regression showed that the significant risk factors associated with NEC were, Oxygen given on day 36, increasing maternal age, conventional ventilation, and blood transfusion. Patent ductus arteriosus (OR 1.41, 95% CI 0.945 – 2.101; P = 0.092) was found to be marginally significant. Conclusion and recommendation- NEC remains predominant among VLBW neonates. Adopting preventive strategies like promoting breastfeeding, antenatal care attendance can help in the reduction of the incidence of NEC among VLBW neonates.