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)
(2024) In Archives of disease in childhood. Fetal and neonatal edition 109(1). p.87-93- Abstract
OBJECTIVE: To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.
DESIGN: Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage ≥II) were validated against hospital records.
PATIENTS: All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden.
MAIN OUTCOME MEASURES: NEC incidence.
RESULTS: The 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... (More)
OBJECTIVE: To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.
DESIGN: Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage ≥II) were validated against hospital records.
PATIENTS: All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden.
MAIN OUTCOME MEASURES: NEC incidence.
RESULTS: The 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).
CONCLUSIONS: The 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.
(Less)
- author
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Archives of disease in childhood. Fetal and neonatal edition
- volume
- 109
- issue
- 1
- pages
- 87 - 93
- publisher
- BMJ Publishing Group
- external identifiers
-
- scopus:85180012220
- pmid:37788898
- ISSN
- 1359-2998
- DOI
- 10.1136/archdischild-2023-325784
- language
- English
- LU publication?
- yes
- additional info
- © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
- id
- 2cc9be42-2a52-4c61-9123-c2b41251a1e7
- date added to LUP
- 2023-10-19 12:08:28
- date last changed
- 2024-04-21 00:03:08
@article{2cc9be42-2a52-4c61-9123-c2b41251a1e7,
abstract = {{<p>OBJECTIVE: To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.</p><p>DESIGN: Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage ≥II) were validated against hospital records.</p><p>PATIENTS: All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden.</p><p>MAIN OUTCOME MEASURES: NEC incidence.</p><p>RESULTS: The 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).</p><p>CONCLUSIONS: The 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.</p>}},
author = {{Challis, Pontus and Källén, Karin and Björklund, Lars and Elfvin, Anders and Farooqi, Aijaz and Håkansson, Stellan and Ley, David and Norman, Mikael and Normann, Erik and Serenius, Fredrik and Sävman, Karin and Hellström-Westas, Lena and Um-Bergström, Petra and Ådén, Ulrika and Abrahamsson, Thomas and Domellöf, Magnus}},
issn = {{1359-2998}},
language = {{eng}},
number = {{1}},
pages = {{87--93}},
publisher = {{BMJ Publishing Group}},
series = {{Archives of disease in childhood. Fetal and neonatal edition}},
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)}},
url = {{http://dx.doi.org/10.1136/archdischild-2023-325784}},
doi = {{10.1136/archdischild-2023-325784}},
volume = {{109}},
year = {{2024}},
}