Outcome of infants with necrotising enterocolitis at Charlotte Maxeke Johannesburg Academic Hospital, South Africa

Abstract

Background. Necrotising enterocolitis (NEC) is an inflammatory disease almost exclusively affecting preterm infants. Previous research has presented a higher mortality rate in infants requiring surgical treatment compared with infants receiving medical treatment. However, the knowledge of mortality and morbidity of the disease in low- and middle-income countries is still limited.

Objectives. To review infants with NEC admitted to the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), determine a potential difference in mortality between medically and surgically treated infants, and to identify characteristics and factors associated with mortality among these infants.

Methods. This retrospective study described infants with NEC born between 1 January 2016 and 31 December 2018 who were admitted to the neonatal unit. The characteristics and survival of these infants were compared using univariate and multivariate analyses.

Results. During the study period, 5 061 infants were admitted to the neonatal unit, of which 218 infants were diagnosed with NEC. The period prevalence of NEC was 4.3% among all neonatal infants and 11.0% among very-low-birthweight (VLBW) infants. Mortality was significantly higher among surgically treated infants with NEC compared with medically treated infants (p=0.025, odds ratio 1.888 (95% confidence interval 1.082 - 3.296)). Late-onset sepsis was significantly more common among VLBW infants with NEC (71.3%) compared with VLBW infants without NEC (27.1%). Among infants with late-onset sepsis, Gram-negative bacteria, multidrug-resistant bacteria and fungal sepsis was significantly more common in the group of infants with NEC.

Conclusions. Infants with NEC treated surgically at CMJAH have an increased risk of dying compared with those receiving medical treatment, likely due to the severity of disease. Furthermore, this study emphasised the burden of sepsis among infants with NEC and may contribute to a better knowledge of NEC in South Africa.