Rotavirus-associated necrotizing enterocolitis: an insight into a potentially preventable disease?

Abstract

Purpose: The aim of this study was to test the hypothesis that rotavirus-associated necrotizing enterocolitis (NEC + RV) differs from NEC associated with other organisms (NEC-RV).

Methods: Neonates with modified Bell stage II or higher NEC were identified. Demographic, clinical, and outcome information was collected prospectively. Fecal specimens from all infants were tested for confirmation of rotavirus infection (RVI) by immunoelectron microscopy (IEM).

Results: Of 2,444 admissions in the neonatal intensive care unit (NICU), 129 (5.3%) had NEC. Thirty-eight (29%) were rotavirus positive. The 2 groups did not differ in maternal or neonatal characteristics. Stage III or higher NEC was more common in the NEC-RV infants (62% v. 39%; P =.032), whereas recurrence was more common in NEC + RV group (P <.0001). The predominant distribution of nondiffuse pneumatosis (n = 52) was right sided in NEC-RV group and left sided in NEC + RV group (P <.0001). Surgical intervention (SI) did not differ between the 2 groups. The complications and mortality rates also were similar. Severe pneumatosis (P =.009) and severe thrombocytopenia (Platelet count < 50,000/mm3; P <.0001) increased, while human milk feedings decreased (P =.022) the odds for surgery. The annual distribution of NEC + RV paralleled RVI in the community.

Conclusions: Generally, NEC + RV is a less severe disease than NEC - RV as classified by modified Bell staging. However, it can reach advanced stages obscuring distinction from NEC - RV. Indications for surgery should not be altered by identification of RVI in these infants. Monitoring RVI in the community, adhering to infection control measures, human milk feedings, and improving neonatal immunity against RVI may reduce the incidence of NEC + RV.