TOP 30 - Necrotizing Enterocolitis in Term Infants: 15-Year Trends in a Level IV NICU

Publication Number: 2781.TOP 30

Krishna Dhanyamraju, Oklahoma Childrens Hospital at OU Health, Oklahoma City, OK, United States; Hala Chaaban, University of Oklahoma Health Campus, Oklahoma, OK, United States

Background: Necrotizing enterocolitis (NEC) remains a leading cause of gastrointestinal morbidity and mortality in neonates, but most research has focused on preterm infants. Term NEC, while uncommon, carries significant morbidity and mortality and may be increasingly encountered in high-acuity referral NICUs that care for complex cardiac and surgical patients. The true burden of NEC in term infants across such centers is not well defined, and the contributing risk factors remain unclear.

Objective: The purpose of this study was to determine how common NEC is among term NICU admissions in a large referral center and to identify factors that may contribute to its development, providing a foundation for improved surveillance and prevention strategies.

Design/Methods: Data from the Vermont Oxford Network (VON) were retrospectively analyzed for 2010-2024 from a Level IV referral NICU that expanded from 60 to 104 beds, established a cardiac NICU in 2014, and initiated neonatal heart transplantation in 2023. All term (≥37 weeks) NICU admissions were included. NEC was defined as Stage ≥II by VON criteria. Annual incidence, surgical management, mortality, and associated risk factors were compared between cardiac and non-cardiac populations.

Annual NEC incidence (%) among all term NICU admissions over a 15-year period.
Incidence increased more than seven-fold (0.3 % to 2.3 %, p<0.01), paralleling NICU expansion and program growth

NEC incidence by congenital heart disease (CHD) status