Trends in incidence and outcomes

of necrotizing enterocolitis over

the last 12 years: A multicenter
cohort analysis
 Sam M. Han
 Charles R. Hong
 Jamie Knell

 Biren P. Modi
 Jeffrey D. Horbar
 Tom Jaksic
 Show all authors

Published:March 12,
2020DOI:https://doi.org/10.1016/j.jpedsurg.2020.02.046

Abstract
Objective
We sought to describe changes in the incidence and
mortality of necrotizing enterocolitis (NEC) and associated
surgical management strategies for very low birth weight
(VLBW) infants.
Methods
Data were prospectively collected on VLBW infants (≤1500 g
or < 29 weeks) born 2006 to 2017 and admitted to 820 U.S.
centers. NEC was defined by the presence of at least one
clinical and one radiographic finding. Trends analyses were
performed to assess changes in incidence and mortality
over time.
Results
Of 473,895 VLBW infants, 36,130 (7.6%) were diagnosed with
NEC, of which 21,051 (58.3%) had medical NEC and 15,079
(41.7%) had surgical NEC. Medical NEC decreased from 5.3%
to 3.0% (p < 0.0001). Surgical NEC decreased from 3.4% to
3.1% (p = 0.06). Medical NEC mortality decreased from 20.7%
to 16.8% (p = 0.003), while surgical NEC mortality decreased
from 36.6% to 31.6% (p < 0.0001). In the surgical cohort, the
use of primary peritoneal drainage (PPD) versus initial
laparotomy rose from 23.2% to 46.8%.
Conclusion
The incidence and mortality of both medical and surgical
NEC have decreased over time. Changes in surgical
management during this time period included the increased
utilization of primary peritoneal drainage.