Outcomes of Neonates Requiring Neonatal Intensive Care Admission for Necrotizing Enterocolitis in a Resource-Restricted Hospital in Cape Town, South Africa

J Trop Pediatr. 2021 Jan 29;67(1):fmaa130. doi: 10.1093/tropej/fmaa130.

Abstract

Aim: The aim of this study is to describe the 30-day mortality, neurodevelopmental outcome and composite outcome (mortality or abnormal neurodevelopmental outcome) of neonates with necrotizing enterocolitis (NEC), requiring neonatal intensive care (NICU) admission, in a resource-restricted environment.

Methods: All neonates admitted to Tygerberg Hospital, NICU, with a presumptive diagnosis of NEC Bell stage IIB or more, over a 5-year period, were included.

Results: One hundred and thirty-five neonates were included with a mean gestational age of 29 ± 2.7 weeks and mean birth weight of 1185 g ± 446 g. The 30-day mortality was 52%, neurodevelopment abnormalities occurred in 35% of survivors and adverse composite outcome in 63%. The 30-day mortality and adverse composite outcome risk were increased by small for gestational age, shock, metabolic acidosis, inotrope requirement and first feed >9 days after surgery.

Conclusion: In resource-restricted environments, mortality and abnormal neurodevelopmental outcome of neonates with NEC, remain high. However, outcomes are comparable with international literature. Neonates with NEC, requiring NICU admission and surgery, require neurodevelopmental follow-up.

Keywords: NEC; necrotizing enterocolitis; outcome; resource restricted.

Plain language summary

Necrotizing enterocolitis remains one of the most common gastrointestinal emergencies in neonates. Neonates admitted to a resource-restricted neonatal intensive care unit with a presumptive diagnosis of advanced NEC were reviewed. We were able to identify risk factors associated with a higher chance of death or poor neurodevelopmental outcomes. Our outcomes are comparable with international literature.

MeSH terms

  • Enterocolitis, Necrotizing* / epidemiology
  • Enterocolitis, Necrotizing* / therapy
  • Hospitals
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Newborn, Diseases*
  • Intensive Care, Neonatal
  • South Africa / epidemiology