6289 The incidence and determinants of necrotising enterocolitis among neonates at a public hospital in South Africa (2013–2018)

Objectives Necrotizing enterocolitis (NEC) is a deadly disease almost entirely affecting neonates.¹ Over the last decade the mortality rate of NEC is recorded to be as high as 50%.¹ ² NEC results from a constellation of prematurity, stress (e.g., sepsis, hypoxia), and a toxic intestinal microbiome that eventually leads to systemic inflammation, inadequate intestinal blood flow, and intestinal tissue death.² Our study aimed to assess the factors associated with NEC among very low birth weight (VLBW; <1500g) neonates in a single center in South Africa. Methods All VLBW neonates born or admitted to the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital from January 2013 to December 2018 who met the inclusion criteria were included in the study. A diagnosis of NEC was determined based on clinical and radiological evidence of stage II or III according to Bell's criteria. Statistical analyses, including multiple logistic regression controlling for confounding factors, were conducted using R software. Ethical clearance was obtained from the Wits Human Research Ethics Council (HREC), clearance number M191062. Results A total of 2943 neonates were included in the study with females being predominant (52%). The median gestational age and median birth weight was 29 and 1120g respectively. Over 10% (312/2631) neonates had NEC out of which almost half of them died 46.5% (145/312; p-value <0.001). A significant rise in the incidence of NEC was observed from 2016 (figure 1). The odds of developing NEC were increased among neonates who had conventional ventilation (aOR 5.7, 95% CI 4.07–8.02, p<0.001), were transfused with blood (aOR 2.3, 95% CI 1.60–3.31, p<0.001), and those whose mothers had chorioamnionitis (aOR 2.0, 95% CI 1.03–3.99, p = 0.04) with statistical significance on performing multivariable logistic regression (figure 2 and table 1). Conclusion The study identifies conventional ventilation, blood transfusion and chorioamnionitis to be significantly associated with NEC among VLBW neonates. These factors would be valuable in refining the treatment modalities for better disease outcomes such as adopting less invasive procedures. References Ginglen JG, Butki N. Necrotizing Enterocolitis In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2023 Jan. PMID: 30020729 2023 Aug 8. Martin CA, Markel TA. Preface: necrotizing enterocolitis. Semin Pediatr Surg 2023;32(3):151303. doi: 10.1016/j.sempedsurg.2023.151303. Epub 2023 May 26. PMID: 37279638.