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Challis, Pontus; Källén, Karin; Björklund, Lars; Elfvin, Anders; Farooqi, Aijaz; Håkansson, Stellan; Ley, David; Norman, Mikael; Normann, Erik; Serenius, Fredrik; Sävman, Karin; Hellström-Westas, Lena; Um-Bergström, Petra; Ådén, Ulrika; Abrahamsson, Thomas; Domellöf, Magnus

Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004–2007 vs 2014–2016)

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  • Media type: E-Article
  • Title: Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004–2007 vs 2014–2016)
  • Contributor: Challis, Pontus; Källén, Karin; Björklund, Lars; Elfvin, Anders; Farooqi, Aijaz; Håkansson, Stellan; Ley, David; Norman, Mikael; Normann, Erik; Serenius, Fredrik; Sävman, Karin; Hellström-Westas, Lena; Um-Bergström, Petra; Ådén, Ulrika; Abrahamsson, Thomas; Domellöf, Magnus
  • Published: BMJ, 2024
  • Published in: Archives of Disease in Childhood - Fetal and Neonatal Edition, 109 (2024) 1, Seite 87-93
  • Language: English
  • DOI: 10.1136/archdischild-2023-325784
  • ISSN: 1359-2998; 1468-2052
  • Keywords: Obstetrics and Gynecology ; General Medicine ; Pediatrics, Perinatology and Child Health
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  • Description: ObjectiveTo investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.DesignRegistry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage ≥II) were validated against hospital records.PatientsAll liveborn infants <27 weeks of gestation 2004–2007 (n=704) and 2014–2016 (n=895) in Sweden.Main outcome measuresNEC incidence.ResultsThe validation process resulted in a 28% reduction of NEC cases but still confirmed a higher NEC incidence in the later epoch compared with the earlier (73/895 (8.2%) vs 27/704 (3.8%), p=0.001), while the composite of NEC or death was lower (244/895 (27.3%) vs 229/704 (32.5%), p=0.022). In a multivariable Cox regression model, censored for mortality, there was no significant difference in early NEC (0–7 days of life) between epochs (HR=0.9 (95% CI 0.5 to 1.9), p=0.9), but being born in the later epoch remained an independent risk factor for late NEC (>7 days) (HR=2.7 (95% CI 1.5 to 5.0), p=0.001). In propensity score analysis, a significant epoch difference in NEC incidence (12% vs 2.8%, p<0.001) was observed only in the tertile of infants at highest risk of NEC, where the 28-day mortality was lower in the later epoch (35% vs 50%, p=0.001). More NEC cases were diagnosed with intramural gas in the later epoch (33/73 (45.2%) vs 6/26 (23.1%), p=0.047).ConclusionsThe increase in NEC incidence between epochs was limited to cases occurring after 7 days of life and was partly explained by increased survival in the most extremely preterm infants. Misclassification of NEC is common.