6290 Outcomes and prognostic factors for survival of neonates with necrotizing enterocolitis at a public hospital in South Africa (2013–2018)

Objectives Necrotizing enterocolitis (NEC) is a life-threatening disease with non-specific causes,¹ ² and it is associated with high morbidity and mortality with common occurrence in neonates with low birth weight and low gestational age.¹ It is crucial to investigate the prognostic factors that determine the survival of neonates especially to mitigate the prevalence and effect of NEC. Methods This was a retrospective observational study of all VLBW neonates that were born or admitted to the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital from January 2013 to December 2018. The survival pattern of neonates according to the length of hospital stay was determined with the descriptive Kaplan-Meier survival function. The log-rank test was used to determine if there is a difference in the survival distribution between the gender and birth weights Lo g rank analysis was used to determine the survival probabilities between groups and cox regression model was used to identify the prognostic risk factors. Results There was a total of 312 neonates who had Bell stage II-III NEC during the six-year period out of which 104 underwent NEC surgery. The overall survival rate was 53.5%. The median length of hospital stay for the non-NEC and NEC group was 27 days and 30 days respectively. From the Kaplan Meier curve, there was a lower probability of survival among neonates who had NEC compared to those who did not have NEC (figure 1). Log-rank analysis showed that blood transfusion, conventional ventilation, mode of delivery, gestational age, NEC surgery and maternal hypertension were significantly associated with the survival of neonates with NEC with a p-value of 0.001, 0.001, 0.014, 0.026, 0.015 and 0.04 respectively. Multivariate cox regression hazard model showed that patent ductus arteriosus, blood transfusion and conventional ventilation were strongly associated with the survival of neonates with NEC with a p-value of 0.047 [HR = 0.5 (95% CI = 0.276 – 0.992)], 0.001 [HR = 4.76 (4.76 – 8.17)], 0.001 [HR = 0.23 (0.13 – 0.4)] respectively (table 1). Conclusion Our study reveals that the surgical approach to treating NEC doesn't improve the chance of survival in neonates. Antenatal care and close monitoring of clinical procedures administered to these neonates are recommended to prevent further morbidity and mortality. References Thomson T, Habeeb O, Dechristopher PJ, Glynn L, Yong S, Muraskas J. Decreased survival in necrotizing enterocolitis is significantly associated with neonatal and maternal blood group: the AB isoagglutinin hypothesis. Journal of Perinatology 2012;32(8):626–30. WB Saunders; Martin CA, Markel TA. Preface: necrotizing enterocolitis. Seminars in Pediatric Surgery 2023;32.