Necrotizing enterocolitis: a prospective multicenter investigation.

Several pre- and post-natal factors possibly important in determining which infants will develop necrotizing enterocolitis (NEC) and which of these infants will die with this disease were prospectively studied in 1976 in 11 infants with radiographic or pathologic evidence of the disease from 12 institutions in the United States and 111 weight-matched, institution-matched control infants. By multivariant discriminant analysis, the authors idenfitied 10 independent significant determinants of NEC and 10 determinants predictive of a fatal outcome among case infants. Determinants of NEC were: Apgar score deterioration; presence of a patent ductus arteriosus; maternal receipt of anesthesia during delivery; infant not treated with parenteral gentamicin before the onset of disease; infant receipt of 10% dextrose solution; treatment of mother with antibiotics during pregnancy; hyperalimentation or gavage feedings; premature rupture of membranes. Important morbid events among cases included red blood cell transfusions, gas in the portal system, premature rupture of membranes, abdominal distension, isolation of Klebsiella organisms from the blood, surgery, prolonged perinatal oxygen requirement, and lower Apgar 2 score. Attempts to modify preventable risk factors may decrease the incidence (2.4 cases per 1000 live births) and case fatality (41%) documented in this study.