TOP 53 - Abdominal Distension in Premature Infants: Distinguishing NEC from CPAP Belly in the CHKD NICU

Publication Number: 4757.TOP 53

Adrienne C. Burgin, ODU-EVMS/CHKD, Norfolk, VA, United States; Julia Worley, Eastern Virginia Medical School, Norfolk, VA, United States; Jenna V. Zschaebitz, Eastern Virginia Medical School, Norfolk, VA, United States; Haree Pallera, ODU / CHKD, Norfolk, VA, United States; Kaitlin Ryan-Smith, Children's Hospital of the King's Daughters, Norfolk, VA, United States

Background: Necrotizing enterocolitis (NEC), a gastrointestinal inflammatory disease, is a devastating complication of neonatal care in preterm infants that can lead to significant morbidity and mortality. Consequences of developing NEC include life-threatening intestinal perforation, sepsis, and/or death with mortality estimated around 20% (Neu et al., 2024). While NEC classically presents with abdominal distension, feeding intolerance, and hemodynamic instability, it can be clinically mimicked by benign abdominal distension related to continuous positive airway pressure (CPAP), commonly known as “CPAP belly”. Since 2022, the Children’s Hospital of the King’s Daughters (CHKD) NICU has used bubble CPAP (bCPAP) because of its non-invasive delivery and evidence towards improving ventilation/perfusion and decreasing respiratory failure in preterm infants. Differentiating between NEC and CPAP belly has been challenging, often requiring aggressive interventions such as cessation of feeds, repeated exposure to antibiotics, and serial x-rays. However, the actual diagnostic incidence of NEC in preterm infants on bCPAP compared to other forms of respiratory support is not well understood in our healthcare system, raising the question: Are preterm babies on bCPAP being evaluated more often for NEC than babies on other forms of respiratory support?

Objective: In this study, we aim to characterize the incidence of NEC in pre-term infants who have been on bCPAP compared to those on other forms of respiratory support in the CHKD NICU between January 2022 and April 2024.

Design/Methods: This is a retrospective study (24-08-WC-0222-CHKD) of infants born ≤32 weeks of gestational age (GA) at the CHKD NICU, admitted January 1, 2022 to April 30, 2024. Incidence of NEC will be determined in infants who have been on bCPAP and the frequency of NEC evaluations in infants who were on bCPAP compared with those on other forms of respiratory support. All statistical tests will be 2-sided, p< 0.05 is significant, and performed using SPSS.28. Continuous variables will be presented as quartiles. Categorical variables will be presented as frequency and percentage. Generalized Linear Model (GLM) will be used to assess the association between use of bCPAP and incidence of NEC, adjusted for the effect of other variables such as GA and weight. We have compiled 379 subjects and are conducting data analysis. Results will be available by January 2026.