Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 103; no. 2; pp. F182 - F189
• Main Authors: Battersby, Cheryl, Santhalingam, Tharsika, Costeloe, Kate, Modi, Neena
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.03.2018
• Subjects: At risk populations; Babies; Birth weight; Childrens health; Developed Countries - statistics & numerical data; Enterocolitis, Necrotizing - epidemiology; Evidence-based medicine; Gastrointestinal diseases; High income; Humans; Incidence; Industrialized nations; Infant, Newborn; Infant, Newborn, Diseases - epidemiology; Infant, Premature; Infant, Premature, Diseases - epidemiology; Infant, Very Low Birth Weight; Mortality; Necrosis; Newborn babies; Observational studies; Pediatrics; Population; Sepsis; Systematic review; Trends; New Zealand; Italy; Austria; Belgium; Australia; United States > US; high-income; preterm; necrotising enterocolitis; babies; incidence
• ISSN: 1359-2998; 1468-2052; 1468-2052
• DOI: 10.1136/archdischild-2017-313880

ObjectiveTo conduct a systematic review of neonatal necrotising enterocolitis (NEC) rates in high-income countries published in peer-reviewed journals.MethodsWe searched MEDLINE, Embase and PubMed databases for observational studies published in peer-reviewed journals. We selected studies reporting national, regional or multicentre rates of NEC in 34 Organisation for Economic Co-operation and Development countries. Two investigators independently screened studies against predetermined criteria. For included studies, we extracted country, year of publication in peer-reviewed journal, study time period, study population inclusion and exclusion criteria, case definition, gestation or birth weight-specific NEC and mortality rates.ResultsOf the 1888 references identified, 120 full manuscripts were reviewed, 33 studies met inclusion criteria, 14 studies with the most recent data from 12 countries were included in the final analysis. We identified an almost fourfold difference, from 2% to 7%, in the rate of NEC among babies born <32 weeks’ gestation and an almost fivefold difference, from 5% to 22%, among those with a birth weight <1000 g but few studies covered the entire at-risk population. The most commonly applied definition was Bell’s stage ≥2, which was used in seven studies. Other definitions included Bell’s stage 1–3, definitions from the Centers for Disease Control and Prevention, International Classification for Diseases and combinations of clinical and radiological signs as specified by study authors.ConclusionThe reasons for international variation in NEC incidence are an important area for future research. Reliable inferences require clarity in defining population coverage and consistency in the case definition applied.PROSPERO International prospective register of systematic reviews registration numberCRD42015030046.