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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)

Challis, Pontus (author)
Umeå University,Umeå universitet,Pediatrik,Umea Univ, Sweden; Umea Univ Klin Vetenskap, Sweden
Källén, Karin (author)
Lund University,Lunds universitet,Miljöepidemiologi,Forskargrupper vid Lunds universitet,Tornbladinstitutet,Environmental Epidemiology,Lund University Research Groups,Tornblad Institute
Björklund, Lars (author)
Lund University,Lunds universitet,Neonatalogi,Forskargrupper vid Lunds universitet,Neonatology,Lund University Research Groups
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Elfvin, Anders, 1971 (author)
University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institute of Clinical Sciences, Department of Pediatrics,Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden; Department of Pediatrics, Sahlgrenska University Hospital, Göteborg, Sweden,Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden
Farooqi, Aijaz (author)
Umeå University,Umeå universitet,Pediatrik,Umea Univ, Sweden
Håkansson, Stellan (author)
Umeå University,Umeå universitet,Pediatrik,Umea Univ, Sweden
Ley, David (author)
Lund University,Lunds universitet,Neonatalogi,Forskargrupper vid Lunds universitet,LTH profilområde: Avancerade ljuskällor,LTH profilområden,Lunds Tekniska Högskola,LU profilområde: Ljus och material,Lunds universitets profilområden,Neonatology,Lund University Research Groups,LTH Profile Area: Photon Science and Technology,LTH Profile areas,Faculty of Engineering, LTH,LU Profile Area: Light and Materials,Lund University Profile areas
Norman, M. (author)
Karolinska Institute,Karolinska Institutet
Normann, E. (author)
Uppsala University
Serenius, Fredrik, 1939- (author)
Umeå University,Umeå universitet,Pediatrik,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden,Umea Univ, Sweden; Uppsala Univ, Sweden
Sävman, Karin, 1960 (author)
University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institute of Clinical Sciences, Department of Pediatrics,Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden,Univ Gothenburg, Sweden
Hellström-Westas, Lena (author)
Uppsala University
Um-Bergström, P. (author)
Karolinska Institute,Karolinska Institutet
Ådén, Ulrika (author)
Karolinska Institute,Karolinska Institutet,Linköpings universitet,Avdelningen för barns och kvinnors hälsa,Medicinska fakulteten,Karolinska Inst, Sweden
Abrahamsson, Thomas (author)
Linköping University,Linköpings universitet,Avdelningen för barns och kvinnors hälsa,Medicinska fakulteten,Region Östergötland, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus
Domellöf, Magnus, 1963- (author)
Umeå University,Umeå universitet,Pediatrik,Umea Univ, Sweden
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 (creator_code:org_t)
BMJ Publishing Group Ltd, 2024
2024
English.
In: Archives of Disease in Childhood-Fetal and Neonatal Edition. - : BMJ Publishing Group Ltd. - 1359-2998 .- 1468-2052. ; 109, s. 87-93
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  • Journal article (peer-reviewed)
Abstract Subject headings
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  • 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.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Pediatrik (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Pediatrics (hsv//eng)

Keyword

Neonatology
Gastroenterology
Gastroenterology

Publication and Content Type

ref (subject category)
art (subject category)

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