Neonatologist Cleveland Clinic Children's Cleveland, Ohio, United States
Background: Several factors have been claimed to the occurrence of necrotizing enterocolitis (NEC) including extreme prematurity, or infection. There is no conclusive evidence that abdominal wall defects are associated with increased incidence of NEC. Objective: To examine the correlation of gastroschisis and/or omphalocele with NEC and describe their demographic and clinical correlations and associated adverse outcomes. Design/Methods: We used the National Inpatient Sample dataset produced by the healthcare cost and utilization project (HCUP) for the years 2016-2020. We identified NEC, omphalocele and gastroschisis using the International Classification of Diseases-Version 10 (ICD10) codes. We included infants of gestational age (GA) > 32 weeks and birth weight (BW) > 1500g and we excluded infants with congenital heart disease and congenital diaphragmatic hernia. We calculated odds ratios to have NEC in association with gastroschisis and/or omphalocele, and we used logistic regression model to calculate adjusted (aOR) while controlling for confounding variables. Results: The study identified 12,942 infants with abdominal wall defects; of them 8488 had gastroschisis and 4607 had omphalocele. The prevalence of NEC in gastroschisis was 6.6% compared to 0.04% among those without gastroschisis, aOR 36.3 (CI: 27.3-48.2, p< 0.001), while the prevalence of surgical NEC with perforation was 2.6% in gastroschisis vs. 0.01% among those without, aOR 46.3 (CI:27.2-68.9, p< 0.001). The prevalence of NEC among infants with omphalocele was 1.7% compared to 0.05% in infants without, aOR 9.38 (CI:4.41-19.9, p< 0.001), while the prevalence of NEC with surgical perforation was 1.1% in those with omphalocele vs. 0.01 among those without, aOR 18.9 (CI:7.46-48.1, p< 0.001). In gastroschisis, occurrence of NEC was associated with higher prevalence of malpresentation, African American race, apnea and anemia of prematurity, and sepsis. In addition, NEC was associated with increased mortality; aOR 2.36 (CI:1.54-3.63, p< 0.001), and prolonged length of stay (LOS); 91(+56) days in infants with NEC vs. 34(+36) days in infants without. In omphalocele, occurrence of NEC was associated with low BW and GA, anemia, and sepsis. While occurrence of NEC was not associated with increased mortality among omphalocele infants, it did increase LOS to 64(+67) days compared to 18(+36) days among infants without.
Conclusion(s): Both gastroschisis and omphalocele are associated with increased incidence of NEC. NEC was associated with increased mortality in gastroschisis but not omphalocele. NEC was associated with increased LOS in both conditions.
