[Risk factors and protective factors in a population a risk for newborn necrotizing enterocolitis]. / Fattori di rischio e fattori protettivi in una popolazione esposta a enterocolite necrotizzante neonatale.

ABSTRACT

NEC represents the most common gastrointestinal disorder in newborn. Its range varies from 1% to 7.7% and is frequently associated with factors such as intestinal ischaemia, prematurity, gastrointestinal infection and early and rapid enteral feeding. Between 15/1/1990 and 15/6/1995, 129 critically ill newborns were admitted in NICU of Policlinico S. Orsola-Bologna. We examined only 93 patients, hospitalized for over 48 hours, presenting one or more risk factors for the development of NEC, such as birthweight < 2000 gm, respiratory distress, gastrointestinal bacterial colonization, sepsis, PDA and use of umbilical catheters. The aim of the study was to evaluate NEC incidence in newborns exposed to this complication and the analysis of risk factors associated with the elements of prevention and protection. No cases of NEC were observed despite the high incidence of risk factors. The newborns studied were divided in six different groups with increasing risk factors. Among the prevention elements of NEC, every patient was treated by nutrition, at first exclusively by TPN followed by careful enteral feeding (< 20 ml/kg/die) and the improvement of mesenteric blood flow by dopamine (2-3 mcg/kg/min); other preventive treatments were given according to clinical condition dobutamine (5-10 mcg/kg/min in 51 ps.) to improve the cardiovascular function, gastrointestinal decontamination (8 ps.), antibiotic therapy (81 ps.), in cases of diagnosed infection and intravenous immunoglobulin (25 ps.) after discovering low ematic values. Analyzing the treatments and their day numbers in the 6 groups of patients no statistically significant differences were evident. On the contrary, dividing the patients into 3 groups according to GA (< 30 w, 30-35 w, > 35 w) an extension in treatment time is more evident in the group of GA < 30 weeks. Our therapeutic behaviour, based on respect of gastrointestinal blood flow, careful and gradual enteral feeding and prevention, constant monitoring and infection treatment, has been useful to stop the NEC incidence.