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. 2018 Dec 4;2(1):e000316.
doi: 10.1136/bmjpo-2018-000316. eCollection 2018.

Intestinal failure after necrotising enterocolitis: incidence and risk factors in a Swedish population-based longitudinal study

Tomas Sjoberg Bexelius  1   2 , Margareta Ahle  3   4 , Anders Elfvin  5 , Oscar Björling  1 , Jonas F Ludvigsson  1   6   7   8 , Roland E Andersson  9   10
Affiliations

Intestinal failure after necrotising enterocolitis: incidence and risk factors in a Swedish population-based longitudinal study

Tomas Sjoberg Bexelius et al. BMJ Paediatr Open. .

Abstract

Background and objective: Paediatric intestinal failure (IF) is a disease entity characterised by gut insufficiency often related to short bowel syndrome. It is commonly caused by surgical removal of a large section of the small intestine in association with necrotising enterocolitis (NEC), which usually affects premature infants. This study investigated the incidence and risk of IF in preterm infants with or without NEC.

Design: A matched cohort study to investigate the incidence and risk factors for IF in a population-based setting in Sweden from 1987 to 2009 using the Swedish Patient Register.

Participants: Infants with a diagnosis of NEC (n=720) were matched for gestational age and year of birth with reference individuals without NEC (n=3656). The study cohort was censored at death, IF or at end of follow-up (2 years of age). We calculated HRs with 95%CIs for IF using Cox regression, adjusting for pertinent perinatal factors.

Results: IF was 15 times more common in the infants with NEC compared with the reference infants (HR=7.2, with 95% CI 3.7 to 14.0). Other risk factors for IF were small for gestational age, extreme preterm birth and abdominal surgery. Neonatal mortality in infants with NEC decreased from 20.6% in 1987-1993 to 10.4% in 2007-2009.

Conclusion: IF was more common in the infants with NEC but was also linked to extreme preterm birth, a history of abdominal surgery and small for gestational age. IF was more common at the end of the study period, indicating that it increases when more preterm infants with NEC survive the neonatal period.

Keywords: gastroenterology; infant feeding; neonatology; nutrition; paediatric surgery.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart describing selection and exclusion of cases and controls. First, NEC cases were identified, cleaned of any multiple registrations and excluded if they did not meet inclusion criteria. Then, controls were randomly selected for each NEC case. *Personal identify number. MBR, Medical Birth Register; NEC, necrotising enterocolitis; NPR, National Patient Register.
Figure 2
Figure 2
Log-log curve showing proportional hazard assumption divided in NEC and reference cohort. Survival time over time is plotted in the NEC versus reference cohort. NEC, necrotising enterocolitis.
Figure 3
Figure 3
Kaplan-Meier table showing survival (time-to event; intestinal failure) stratified on type of cohort, NEC versus reference cohort. NEC, necrotising enterocolitis.
See this image and copyright information in PMC

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