Neonatal necrotizing enterocolitis. A 10 year experience.

Neonatal necrotizing enterocolitis was seen in 42 of 5,030 infants (0.83 percent) admitted to our neonatal intensive care units. The condition developed more than 1 week after birth in most infants. This group included most of the very low birth weight infants. Forty-one of the 42 infants had enteral feedings before the onset of enterocolitis, which developed within 72 hours from the start of feedings in 19 infants (45 percent). Twenty-nine patients (69 percent) underwent surgery. Mortality in this group was 38 percent overall and 28 percent in the infants considered salvageable at laparotomy. The interval from diagnosis to surgery was 24 hours or less in 65 percent of cases, emphasizing the fulminant nature of the disease in many patients. Three of the 14 patients who died underwent no surgery. Pneumoperitoneum was one of the initial radiologic signs in 10 patients (24 percent). The necrotizing enterocolitis observed was similar clinically to that reported by others. The strikingly low incidence of enterocolitis in the neonatal intensive care units in Oregon (0.83 percent) contrasts with the generally reported incidence of 3 to 8 percent in other neonatal intensive care units. We attribute the low incidence of necrotizing enterocolitis in our experience to delay of enteral feedings and reliance on prolonged peripheral or central total parenteral nutrition, or both, for nutritional maintenance of stressed or low birth weight infants.