Fulminant necrotizing enterocolitis in a multihospital ... - Nature

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May 12, 2011 - Hospital Center, Ogden, UT, USA; 3Institute for Healthcare Delivery Research, ... University of Utah School of Medicine, Salt Lake City, UT, USA and ... Conclusion: Portal venous air, anemia, rapid feeding escalation, a high.
Journal of Perinatology (2012) 32, 194–198 r 2012 Nature America, Inc. All rights reserved. 0743-8346/12 www.nature.com/jp

ORIGINAL ARTICLE

Fulminant necrotizing enterocolitis in a multihospital healthcare system DK Lambert1,2, RD Christensen1,2, VL Baer1,2, E Henry1,3, PV Gordon4, GE Besner5, J Wilkes1,3, SE Wiedmeier1,6 and E Gerday1,7 1

Women and Newborns Program, Intermountain Healthcare, Salt Lake City, UT, USA; 2Division of Neonatology, McKay-Dee Hospital Center, Ogden, UT, USA; 3Institute for Healthcare Delivery Research, Salt Lake City, UT, USA; 4Division of Neonatology, Department of Pediatrics, Tulane School of Medicine, New Orleans, LA, USA; 5Department of Surgery, Nationwide Children’s Hospital, Columbus, OH, USA; 6Division of Neonatology, Intermountain Medical Center and Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA and 7Division of Neonatology, Utah Valley Regional Medical Center, Provo, UT, USA

Objective: A subset of necrotizing enterocolitis (NEC) cases is fulminant, characterized by rapid progression to death with massive bowel necrosis found at laparotomy or autopsy. We sought to identify and report all such cases in a multihospital healthcare system during the past 9 years and to characterize this entity using case-control methodologies.

Study Design: This was a multicentered, cross-sectional, historic cohort study conducted using Intermountain Healthcare hospital patient data. All neonates who died of NEC within 48 h of onset, during 2001 to 2009, were compared with two matched control groups: (1) demographically matched controls who developed non-fulminant NEC, (2) demographically matched controls that did not develop NEC. Result: During this period, 2 71 327 live births occurred in the Intermountain Healthcare hospitals. Of these, 318 had a diagnosis of NEC (Bell stage XII). Also during this period, 205 other neonates were transferred into an Intermountain hospital for treatment of NEC. Of these 523 NEC cases, 35 (6.7%) had a fulminant course. Compared with the non-fulminant cases, the fulminant group were born at lower weight (1088±545 vs 1652±817 g, P ¼ 0.000) and earlier gestational age (27.5±3.3 vs 31.1±4.4 weeks, P ¼ 0.000), and were more likely to have: (1) radiographic evidence of portal venous air (P ¼ 0.000), (2) hematocrit 20 ml/kg/day (P ¼ 0.003), (4) immature to total (I/T) neutrophil ratio >0.5 (P ¼ 0.005), (5) blood lymphocyte count