National prospective surveillance study of necrotizing enterocolitis in neonatal intensive care units

Purpose: There is scant epidemiological data on necrotizing enterocolitis (NEC), so we conducted a national study to characterize prevalence, surgical management, and mortality. Methods: A prospective cross-sectional survey was performed in the United Kingdom requesting data from 158 level 2 and 3 neonatal intensive care units (NICUs) during 2 winter and 2 summer months in 2005 to 2006; 51% of questionnaires were returned. Results are given as percentage with 95% confidence intervals. Results: (1) Period prevalence: 211 infants were diagnosed with NEC (45% Bell's stage I, 21% stage II, and 33% stage III) from a total of 10,946 NICU admissions, with a period prevalence of 2% (1.7-2.2). In infants less than 1000 g birth weight, the prevalence was 14% (12-16), and in less than 26 weeks of gestation, 14% (11-17). Prevalence decreased significantly with increasing birth weight (P<.0001) and increasing gestation (P<.0001). (2) Surgery: 66 infants received surgical procedures; peritoneal drain in 13 (followed by laparotomy in 8) and in 53, laparotomy alone. (3) Mortality: 27 infants died with NEC of a total 283 deaths, thus, accounting for 9.5% of NICU mortality. Eight (30%) infants with NEC died without surgery. Conclusions: Prevalence of NEC in the United Kingdom is high and comparable to published series in other countries from the 1990s. There may be a hidden mortality in patients who do not receive surgery. (C) 2010 Elsevier Inc. All rights reserved.