Incidence and Predictors of Necrotizing Enterocolitis Among Low-Birth-Weight Neonates Admitted to Southern Ethiopian Public Hospitals

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Necrotizing enterocolitis (NEC) has emerged over the past 25 years as the most common gastrointestinal emergency in neonatal intensive care units (NICUs) worldwide. Despite significant improvements in survival among premature and low-birth-weight (LBW) neonates due to advances in neonatal intensive care, the incidence of NEC remains persistently high, largely because of the physiological vulnerability associated with LBW and prematurity. The purpose of this study was to assess the incidence and identify predictors of NEC among LBW newborns in South Ethiopia. A hospital-based prospective cohort study was conducted among 627 LBW neonates in public hospitals in southern Ethiopia from December 2, 2020, to December 1, 2021. Data were coded and entered into Epi-data version 4.4.2.1 and exported to STATA version 17 for analysis. Weibull regression analysis was employed after assessing model fitness. Adjusted hazard ratio (AHR) with 95% confidence interval (CI) was calculated, and variables with a P value < .05 were considered statistically significant. The incidence rate of NEC among LBW neonates was 11.7 per 1000 child-day observations (95% CI: 8.95-15.26). Maternal age (25-35 years) (AHR = 2.45 [95% CI: 1.16-5.15]) and advanced maternal age (>35 years) (AHR = 3.68 [95% CI: 1.33-10.19]) were significantly associated with an increased risk of NEC. Other independent predictors of NEC included preeclampsia (AHR = 2.49 [95% CI: 1.18-5.31]), oligohydramnios (AHR = 9.80 [95% CI: 1.11-86.89]), intraventricular hemorrhage (IVH) (AHR = 7.56 [95% CI: 1.58-36.21]), neonatal jaundice (AHR = 2.03 [95% CI: 1.09-3.81]), dehydration (DHN) (AHR = 10.75 [95% CI: 2.33-49.63]), formula feeding (AHR = 4.71 [95% CI: 1.86-11.95]) and not initiated feeding early (AHR = 9.36 [95% CI: 4.17-20.98]]). This study revealed a high incidence rate of NEC among LBW neonates. To mitigate the burden of NEC among LBW neonates, targeted interventions aimed at preventing and effectively managing pregnancy-related complications, particularly preeclampsia and oligohydramnios, should be strengthened. In addition, early diagnosis and prompt treatment of neonatal conditions, including intraventricular hemorrhage, jaundice, and dehydration, are critical to decrease NEC. Promoting breastfeeding and encouraging early initiation of feeding are also key strategies for the effective prevention of NEC.

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