Abdur Rehman Malik, Ahmed Iqbal Quddusi, Imran Iqbal, Mukhtar Hussain Bhatti.
Evaluation Risk Factors of Necrotizing Enterocolitis; Children Hospital and the Institute of Child Health Multan.
Professional Med J Jan ;25(5):647-53.

Introduction: Necrotizing enterocolitis (NEC) is a condition where the intestines become infected and can begin to die. Necrotizing enterocolitis is a serious condition that may require surgery, and has a high morbidity and mortality rate. Objectives: To evaluate the risk factors of necrotizing enterocolitis among neonates at children hospital Multan. Study Design: Descriptive Cross-sectional study. Setting: Neonatal Unit of Children Hospital and Institute of Child Health Multan. Period: October 2015 to September 2016. Material and Methods: A total of 79 neonates presented with necrotizing enterocolitis were enrolled for the possible causes. The parameters studied included gestational age at birth, birth weight, maternal risk factors, patient risk factors, age when feeding was started, type of feed, age when signs of NEC appeared, per feed increment, presence of any antecedent associations, clinical features, radiological features, blood investigations (complete blood counts, blood glucose, serum sodium, serum potassium, serum creatinine, liver function tests), ABGs, stool for occult blood and culture, septic screening and blood culture, management(medical or surgical) and outcome. The data was analyzed using SPSS-20. Results: Out of a total of 79 neonates, 48 (60.8%) were male and 31(39.2%) female. There were 71% infants who were younger than 32 gestational weeks and 67.7% under 1500 grams. The majority of neonates 62 (78.5%) commenced enteral feeds within the first 24 hours. First feeding was started at a mean 5.6 ± 3.85 (2-17) days. Prematurity was the commonest factor and present in 63 (79.9%) neonates. Abdominal distention was the commonest symptoms 55% followed by bilious vomiting in 15%. Blood culture was positive in 22 (27.8%) with predominance of gram negative microorganisms. According to Bell?s staging, 54 (68.35%) neonates had stage I, 17 (21.5%) stage II, and 8 (10.1%) neonates were in stage III. Conclusion: In most of the cases, the causes of necrotizing enterocolitis were present and prematurity was the main etiological factor. Cautiously introducing enteral feeds using expressed maternal breast milk and increasing feed volumes slowly is important in reducing the incidence amongst high risk individuals.

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