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Factors associated with the increased incidence of necrotising enterocolitis in extremely preterm infants in Sweden between two population-based national cohorts (2004-2007 vs 2014-2016)
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.ORCID iD: 0000-0002-7511-7217
Department of Clinical Sciences, Obstetrics and Gynecology, Lund University Faculty of Medicine, Lund, Sweden.
Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden.
Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden; Department of Pediatrics, Sahlgrenska University Hospital, Göteborg, Sweden.
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2023 (English)In: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 109, no 1, p. 87-93Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate potential risk factors behind the increased incidence of necrotising enterocolitis (NEC) in Swedish extremely preterm infants.

DESIGN: Registry data from two population-based national cohorts were studied. NEC diagnoses (Bell stage ≥II) were validated against hospital records.

PATIENTS: All liveborn infants <27 weeks of gestation 2004-2007 (n=704) and 2014-2016 (n=895) in Sweden.

MAIN OUTCOME MEASURES: NEC incidence.

RESULTS: The validation process resulted in a 28% reduction of NEC cases but still confirmed a higher NEC incidence in the later epoch compared with the earlier (73/895 (8.2%) vs 27/704 (3.8%), p=0.001), while the composite of NEC or death was lower (244/895 (27.3%) vs 229/704 (32.5%), p=0.022). In a multivariable Cox regression model, censored for mortality, there was no significant difference in early NEC (0-7 days of life) between epochs (HR=0.9 (95% CI 0.5 to 1.9), p=0.9), but being born in the later epoch remained an independent risk factor for late NEC (>7 days) (HR=2.7 (95% CI 1.5 to 5.0), p=0.001). In propensity score analysis, a significant epoch difference in NEC incidence (12% vs 2.8%, p<0.001) was observed only in the tertile of infants at highest risk of NEC, where the 28-day mortality was lower in the later epoch (35% vs 50%, p=0.001). More NEC cases were diagnosed with intramural gas in the later epoch (33/73 (45.2%) vs 6/26 (23.1%), p=0.047).

CONCLUSIONS: The increase in NEC incidence between epochs was limited to cases occurring after 7 days of life and was partly explained by increased survival in the most extremely preterm infants. Misclassification of NEC is common.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023. Vol. 109, no 1, p. 87-93
Keywords [en]
Gastroenterology, Neonatology
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:umu:diva-218668DOI: 10.1136/archdischild-2023-325784ISI: 001080788400001PubMedID: 37788898Scopus ID: 2-s2.0-85180012220OAI: oai:DiVA.org:umu-218668DiVA, id: diva2:1822871
Funder
Region VästerbottenRegion Stockholm, 2020-0443Region SkåneSwedish Research Council, 2019-01005Swedish Research Council, 2020-01236Swedish Heart Lung Foundation, 20200808Swedish Order of FreemasonsAvailable from: 2023-12-28 Created: 2023-12-28 Last updated: 2023-12-28Bibliographically approved

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Challis, PontusFarooqi, AijazHåkansson, StellanSerenius, FredrikDomellöf, Magnus

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