Necrotizing enterocolitis (NEC) is a common disease, often requiring surgery, in premature neonates. It does occur rarely in full-term neonates (GA ≥38 weeks). In this study, the maternal and neonatal risk factors and underlying pathology that may precipitate NEC in term neonates was investigated.
A retrospective study was done over an 8-year period (Jan2009 – Mar 2017) for NEC in term neonates. We included a comparable group of term non-NEC neonates over the same period to assess the maternal and neonatal factors in comparison to findings obtained in NEC neonates.
Ethics approved: IRB0005239
The total number of NEC (managed conservatively or surgically) in the study period was 194 patients, 14 of them were term neonates. Non-NEC comparison group was 30 patients.
Maternal risk factors: maternal age, Rh status, nicotine usage, acute/chronic medication and gestational-related illness did not differ significantly to non-NEC group. However maternal methamphetamine abuse (4/14) was significant in NEC term neonates in comparison to (0/30) non-NEC term neonates (P-value <0.05).
Neonatal risk factors: genetics disorder, mode of delivery, type of milk, invasive procedures (eg central venous line insertion) were not significant but cardiac anomaly (8/14) was significant in NEC term neonates in comparison to (0/30) non-NEC term neonates (P-value <0.01).
Term neonates with NEC are a relatively infrequent disease. Cardiac anomalies are well known to precipitate the disease in premature or full-term neonates, as noted in this cohort. Methamphetamine usage, which acts as a central and peripheral dopamine-reuptake inhibitor, was also noted as a possible underlying cause for unknown reason. It may be due to direct dopamine effect on the bowel or its blood supply. This association should alert paediatrician and paediatric surgeons to closely monitor at risk full-term neonates for development of NEC.