Objective: To investigate a necrotizing enterocolitis (NEC) cluster of
late preterm and term neonates (gestational age34 weeks).Methods: We
conducted a descriptive and a case-control study. Medical records of
neonates with modified Bell stageIB NEC and matched controls were
reviewed, in addition to microbiological and environmental
investigation. Study variables included maternal/delivery and neonatal
factors, medications, procedures and feeding practices.
Univariable/multivariable logistic regression analyses were performed
for all and for stageII cases.Results: Out of 1841 late preterm and term
neonates, 10 stage IB and 10 stageII [mean(SD) birthweight 2529.3
(493.04) g, gestational age 36.96 (1.48) weeks] presented with NEC
symptomatology at mean 4.6 (range 2-8) days. Nearly all (19/20) resulted
from high-risk pregnancies and received postpartum intermediate care.
All were exclusively or partly formula fed. Most (14/20) were born by
cesarean delivery. Eight underwent surgery, with no fatality.
Intermediate care (p=0.006), transient tachypnea (p=0.049), not
receiving breast milk (p=0.019) and in addition intrauterine growth
restriction (IUGR) (p=0.017) for stageII cases were independently
associated with NEC.Conclusions: Late preterm and term neonates in need
of intermediate care, with IUGR and transient tachypnea were susceptible
to NEC; feeding with breast milk was an important protective factor
