Acute kidney injury in newborns with necrotizing enterocolitis: risk factors and mortality / Daño renal agudo en recién nacidos con enterocolitis necrotizante: factores de riesgo y mortalidad

Abstract Background: Both necrotizing enterocolitis and acute kidney injury are tightly related conditions, which independently increase mortality in newborns. Necrotizing enterocolitis is an inflammatory disease with a systemic repercussion that leads to inflammatory kidney changes predisposing to renal damage. Methods: This study assessed risk factors for the development of acute kidney injury in patients diagnosed with necrotizing enterocolitis and compared mortality between patients with or without acute kidney injury. Thirty-nine patients with the diagnosis of necrotizing enterocolitis were included, regardless of the gestational age. Results: Of 39 patients, 38.5% developed acute kidney injury. Survival showed to be significantly lower in patients with acute kidney injury (54.4 days) when compared to newborns without acute kidney injury (76.22 days; p = 0.014). Mortality in patients with acute kidney injury was 46.7%, increasing up to 62.5% with severe kidney damage. The hazard ratio for mortality was 4.708 for acute kidney injury (p = 0.025). The severity of enterocolitis showed to be an independent risk factor in developing acute kidney injury and severe kidney injury (odds ratio [OR] = 1.841, p = 0.034 and OR = 1.917, p = 0.027, respectively). Conclusions: Newborns with necrotizing enterocolitis should be evaluated for early recognition of acute kidney injury. Prospective studies with a higher number of patients are needed to identify modifiable risk factors to impact in the prevention of these conditions.

Resumen Introducción: La enterocolitis necrosante y el daño renal agudo son condiciones íntimamente relacionadas que incrementan independientemente la mortalidad en recién nacidos. La enterocolitis necrosante es una enfermedad inflamatoria sistémica que desencadena cambios renales inflamatorios, predisponiendo el desarrollo de daño renal. Métodos: Se analizaron los factores de riesgo para el desarrollo de daño renal agudo en pacientes con diagnóstico de enterocolitis necrosante y se comparó la mortalidad entre los pacientes sin daño renal y los pacientes con daño renal agudo. Se incluyeron 39 pacientes con diagnóstico de enterocolitis necrosante, independientemente de la edad gestacional. Resultados: De los 39 pacientes, el 38.5% desarrolló daño renal agudo. La sobrevida de los que desarrollaron daño renal agudo (54.4 días) mostró ser significativamente menor al compararse con los recién nacidos que no presentaron daño renal (76.22 días; p = 0.014). La mortalidad en los pacientes con daño renal agudo fue del 46.7%, que se incrementó hasta el 62.5% en aquellos con daño renal grave. El riesgo de mortalidad fue de 4.708 para daño renal agudo (p = 0.025). La gravedad de la enterocolitis necrosante demostró ser un factor de riesgo independiente para el desarrollo de daño renal agudo y de daño renal agudo severo (razón de momios [RM] = 1.841; p = 0.034 y RM = 1.917; p = 0.027, respectivamente). Conclusiones: Los recién nacidos con diagnóstico de enterocolitis necrosante deben ser evaluados para reconocer de forma temprana la presencia de daño renal agudo. Se requiere de estudios prospectivos con mayor número de pacientes para identificar factores de riesgo modificables que puedan impactar en la prevención de estas patologías.

Tratamiento antibiótico empírico inicial prolongado y riesgo de morbimortalidad en recién nacidos de muy bajo peso al nacer / Prolonged initial empirical antibiotic treatment and the risk of morbidity and mortality in very low birthweight infants

Resumen: Introducción: El objetivo de este estudio es evaluar la asociación entre la duración del tratamien to antibiótico empírico inicial y el desarrollo posterior de sepsis tardía, enterocolitis necrotizante (NEC) y muerte en recién nacidos de muy bajo peso al nacer (RNMBP). Pacientes y Método: Estudio cuantitativo, transversal analítico, en RNMBP ingresados a UCI neonatal durante un período de 5 años. Se consideró antibioterapia empírica inicial aquella que comenzó desde el nacimiento, sin conocer resultado de hemocultivos. Antibioterapia prolongada se estimó cuando la duración del tratamiento fue > 5 días. Se analizaron variables perinatales, e incidencia de sepsis tardía, NEC confirmada y mortalidad. Resultados: Se estudiaron un total de 266 RNMBP, con edad gestacional y peso de nacimiento promedios de 28,8 ± 2,5 semanas y 1.127 ± 264 g respec tivamente. Recibieron antibioterapia empírica inicial 213 (80,0%), siendo ésta prolongada en el 67,6%. Todos recibieron antibioterapia biasociada. Se pesquisaron 136 episodios de sepsis tardía, siendo los gérmenes más frecuentes el Staphylococcus coagulasa negativo y el Staphylococcus au reus. Del total de RN con antibioterapia empírica prolongada, hubo 20 casos de NEC confirmada y 15 fallecidos (10,4%) en el grupo analizado. Al comparar el uso de antibioterapia > 5 días ver sus tratamiento menor de 5 días, se observó una asociación estadísticamente significativa entre la antibioterapia prolongada y sepsis tardía (p = 0,03) y además de NEC confirmada (p = 0,03), pero no de mortalidad (p = 0,12). Conclusión: El uso de antibioterapia empírica inicial por 5 días o más se asoció a un riesgo aumentado de sepsis tardía y de NEC, pero no de la mortalidad en RNMBPN.

Abstract: Introduction: The objective of this study is to evaluate the association between the duration of ini tial empirical antibiotic treatment and the subsequent development of late-onset sepsis, necrotizing enterocolitis (NEC) and death in very low birth weight (VLBW) infants. Patients and Methods: Quantitative, cross-sectional, analytical study of VLBW infants admitted to the neonatal ICU were included over a period of five years. Initial empirical antibiotic therapy was that which started im mediately after birth, without knowing the results of blood cultures. It was considered prolonged antibiotic therapy when the treatment duration was > 5 days. Perinatal variables, as well as the inci dence of late-onset sepsis, confirmed NEC and mortality were analyzed. Results: 266 VLBW infants were studied, with an average gestational age and birth weight of 28.8 ± 2.5 weeks and 1.127 ± 264 g respectively. 213 infants received initial empiric antibiotic therapy (80.0%), which was prolonged in 67.6% of cases. All infants received two different antibiotics. 136 episodes of late-onset sepsis were described. The most common pathogens were coagulase-negative Staphylococcus and Staphylococcus aureus. Among the newborns with prolonged antibiotic therapy, there were 20 cases of confirmed NEC and 15 of the studied infants died (10.4%). When comparing the use of antibiotic therapy during > 5 days versus treatment less than 5 days duration, a statistically significant association was observed between prolonged antibiotic therapy and late-onset sepsis (p = 0.03) and confirmed NEC (p = 0.03), but not of mortality (p = 0.12). Conclusion: The use of empirical antibiotic therapy for five days or more was associated with an increased risk of late-onset sepsis and NEC, but not of mortality in VLBW infants.

There is an association between disease location and gestational age at birth in newborns submitted to surgery due to necrotizing enterocolitis / Existe associação entre a localização da doença e a idade gestacional ao nascimento de recém-nascidos operados por enterocolite necrosante

Abstract Objectives To evaluate if there are differences regarding disease location and mortality of necrotizing enterocolitis, according to the gestational age at birth, in newborns submitted to surgery due to enterocolite. Methods A historical cohort study of 198 newborns submitted to surgery due to necrotizing enterecolitis in a tertiary hospital, from November 1991 to December 2012. The newborns were divided into different categories according to gestational age (<30 weeks, 30-33 weeks and 6 days, 34-36 weeks and 6 days, and ≥37 weeks), and were followed for 60 days after surgery. The inclusion criterion was the presence of histological findings of necrotizing enterocolitis in the pathology. Patients with single intestinal perforation were excluded. Results The jejunum was the most commonly affected site in extremely premature infants (p = 0.01), whereas the ileum was the most commonly affected site in premature infants (p = 0.002), and the colon in infants born at term (p < 0.001). With the increasing gestational age, it was observed that intestinal involvement decreased for the ileum and the jejunum (decreasing from 45% to 0% and from 5% to 0%, respectively), with a progressive increase in colon involvement (0% to 84%). Total mortality rate was 45.5%, and no statistical difference was observed in the mortality at different gestational ages (p = 0.287). Conclusions In newborns submitted to surgery due to necrotizing enterocolitis, the disease in extremely preterm infants was more common in the jejunum, whereas in preterm infants, the most affected site was the ileum, and in newborns born close to term, it was the colon. No difference in mortality was observed according to the gestational age at birth.

Resumo Objetivos Avaliar se há diferença de localização e de mortalidade da enterocolite necrosante de acordo com a idade gestacional ao nascimento, em neonatos operados por enterocolite. Métodos Coorte histórica de 198 neonatos operados por enterocolite necrosante em hospital terciário, de novembro de 1991 a dezembro de 2012. Os recém-nascidos operados foram divididos em diferentes categorias de acordo com a idade gestacional (< 30 semanas, 30 a 33 semanas e seis dias, 34 a 36 semanas e seis dias e ≥ 37 semanas) e foram seguidos por 60 dias depois da cirurgia. O critério de inclusão foi a presença de achados histológicos de enterocolite necrosante no anatomopatológico e o de exclusão foi a presença de perfuração intestinal única. Resultados O jejuno foi mais acometido pela ECN nos prematuros extremos (p = 0,01); o íleo mais afetado nos recém-nascidos prematuros (p = 0,002) e o cólon nos recém-nascidos a termo ou próximos ao termo (p < 0,001). Com o aumento da idade gestacional, observam-se redução do acometimento do jejuno e do íleo (regrediu de 45% para 0% e de 5% para 0%, respectivamente) e aumento progressivo do acometimento do cólon (0% para 84%). A mortalidade total das crianças operadas por ECN foi de 45,5%; não existiu diferença estatística na mortalidade nas diferentes idades gestacionais (p = 0,287). Conclusões Em recém-nascidos operados por enterocolite necrosante, a doença no jejuno foi mais comum no prematuro extremo, no íleo no prematuro, e a doença no cólon nos recém-nascidos próximos ao termo. Não foi observada diferença de mortalidade de acordo com a idade gestacional ao nascimento.

Efectividad del SURFACEN ® en neonatos prematuros con síndrome de dificultad respiratoria / Effectiveness of SURFACEN ® in preterm infant with respiratory distress syndrome

Introducción: el SURFACEN® es un surfactante natural cubano, de origen porcino, que desde su registro sanitario en 1995, se prescribe para tratar el Síndrome de Dificultad Respiratoria del pretérmino. Objetivo: ratificar la efectividad del SURFACEN® en recién nacidos pretérmino con síndrome de dificultad respiratoria. Método: se diseño un estudio descriptivo, longitudinal, prospectivo, de seguimiento poscomercialización, no controlado, multicéntrico nacional, durante el periodo comprendido del 2007 al 2009. El universo de estudio estuvo constituido por 259 recién nacidos con síndrome de dificultad respiratoria y menos de 37 semanas de edad gestacional, a los que se les administró SURFACEN®. La variable principal para evaluar la efectividad del surfactante fue la mortalidad neonatal. Resultados: predominó el sexo masculino en el 58,7 por ciento y los nacidos por cesárea en el 66,4 por ciento. Se aplicó como rescate tardío, el tiempo en ventilación mecánica fue de siete días y la mortalidad fue de un 19,7 por ciento, las complicaciones con mayor riego de morir fue la enterocolitis necrotizante. Conclusión: el SURFACEN® en la práctica clínica habitual demostró su efectividad(AU)

Introduction: SURFACEN® is a Cuban natural surfactant of swine origin, which since its sanitary registration in 1995, is prescribed to treat respiratory distress syndrome in preterm infants. Objective: to ratify the effectiveness of SURFACEN® in preterm infants with respiratory distress syndrome. Method: anational descriptive, longitudinal, prospective, post-market monitoring, uncontrolled and multicentered study was designed and conducted during the period from 2007 to 2009. The universe of study consisted of 259 infants with respiratory distress syndrome and less than 37 weeks old gestational age, who were administered SURFACEN®. The primary endpoint for evaluation of the surfactant effectiveness was neonatal mortality. Results: males prevailed in 58.7 percent and those born by Caesarean section in 66. 4 percent. It was applied as late rescue, length of time on mechanical ventilation was seven days and mortality was 19.7 percent, the complications with the highest risk of dying were necrotizing enterocolitis. Conclusions: SURFACEN® demonstrated its effectiveness in clinical practice(AU)

A meta-analysis of probiotics for preventing necrotizing enterocolitis in preterm neonates

Necrotizing enterocolitis (NEC) is one of the most common acquired diseases of the gastrointestinal tract in preterm infants. Some randomized, controlled trials (RCTs) have indicated that probiotics may potentially lower the incidence of NEC and mortality. However, debate still remains about the safety of probiotics and their influence on normal infant growth. We performed this meta-analysis to assess the safety and benefits of probiotic supplementation in preterm infants. We searched in PubMed, Embase, and Cochrane databases for English references, and in Wanfang, VIP, and CNKI databases for Chinese references. Ultimately, 27 RCTs (including 9 Chinese articles) were incorporated into this meta-analysis. Relative risk (RR) and weighted mean difference (WMD) were calculated using a random-effects or fixed-effects model, depending on the data type and heterogeneity. A total of 6655 preterm infants, including the probiotic group (n=3298) and the placebo group (n=3357), were eligible for inclusion in this meta-analysis. For Bell stage ≥I and gestational age <37 weeks, risk of NEC incidence was significantly lower in the probiotic group [RR=0.35, 95% confidence interval (CI)=0.27-0.44, P<0.00001]. For Bell stage ≥II or gestational age <34 weeks, there were likewise significant differences between the probiotic and placebo groups concerning NEC incidence (RR=0.34, 95%CI=0.25-0.48, P<0.00001; and RR=0.39, 95%CI=0.27-0.56, P<0.00001). Risk of death was significantly reduced in the probiotic group (RR=0.58, 95%CI=0.46-0.75, P<0.0001). In contrast, there was no significant difference concerning the risk of sepsis (RR=0.94, 95%CI=0.83-1.06, P=0.31). With respect to weight gain and the age at which infants reached full feeds, no significant differences were found between the probiotic and placebo groups (WMD=1.07, 95%CI=−0.21-2.34, P=0.10; and WMD=−1.66, 95%CI=−3.6-0.27, P=0.09). This meta-analysis has shown that, regardless of gestational age and NEC stage, probiotic supplementation could significantly reduce the risk of NEC in preterm infants. Analysis also indicated that such supplementation did not increase the incidence risk of sepsis or of mortality. Finally, the study showed that probiotic supplementation may have no adverse effect on normal feeding and growth.

Eficácia dos probióticos na profilaxia de enterocolite necrosante em recém-nascidos prematuros: revisão sistemática e meta-análise / Effectiveness of probiotics in the prophylaxis of necrotizing enterocolitis in preterm neonates: a systematic review and meta-analysis

OBJETIVO: Elucidar os benefícios do uso de probióticos na prevenção de enterocolite necrosante (ECN) e de suas complicações em recém-nascidos prematuros. MÉTODO: Revisão sistemática de ensaios clínicos randomizados, que incluiu pesquisas efetuadas em três bases de dados (MEDLINE, EMBASE e LILACS), utilizando a combinação dos termos (necrotizing enterocolitis) AND (probiotics). RESULTADOS : Foram incluídos 11 ensaios clínicos randomizados, totalizando 2.887 pacientes, sendo 1.431 no grupo Probiótico e 1.456 no grupo Controle. Houve redução na incidência de ECN (NNT = 25), de morte global (NNT = 34) e sepse neonatal (NNT = 34) no grupo Probiótico em relação ao grupo Controle. Pacientes alimentados com suplementação de probióticos tiveram tempo de reintrodução alimentar (p < 0,001) e de hospitalização (p < 0,001) menor quando comparados aos que não receberam. Não houve diferença na mortalidade causada por ECN. CONCLUSÃO: Em recém-nascidos prematuros, o uso de probióticos é eficaz na profilaxia de ECN e de suas complicações.

OBJECTIVE: To elucidate the benefits of using probiotics in the prevention of necrotizing enterocolitis (NEC) and its complications in preterm newborns. METHOD: This was a systematic review of randomized controlled trials, which included studies retrieved from three databases (MEDLINE, Embase, and LILACS), using a combination of the terms (necrotizing enterocolitis) AND (probiotics). RESULTS: 11 randomized trials were included, totaling 2,887 patients, 1,431 in the probiotic group and 1,456 in the control group. There was a reduction in the incidence of NEC (NNT = 25), overall death (NNT = 34), and neonatal sepsis (NNT = 34) in the probiotic group compared to the control group. Patients that received probiotic supplementation had lower food reintroduction time (p < 0.001) and hospitalization time (p < 0.001) when compared to those not receiving probiotics. There was no difference in mortality caused by NEC. CONCLUSION: In premature newborns, the use of probiotics is effective as a prophylaxis for NEC and its complications.

Validation of protocol of experimental necrotizing enterocolitis in rats and the pitfalls during the procedure / Validação do modelo de enterocolite necrotizante experimental em ratos e as armadilhas durante sua execução

PURPOSE: To describe the difficulties of implementing the protocol of experimental necrotizing enterocolitis (NEC) in order to obtain a larger number of newborns affected with the disease and a lower mortality. METHODS: Term Sprague-Dawley newborns rats (22 days) were divided into four groups of 12 fetuses each (n = 48): EC - breastfed newborns; IH - breastfed newborns and subjected to a stress protocol by ischemia and hypothermia; ESB - formula-fed newborns (Esbilac®, PetAg, Hampshire, IL, USA) and NEC - formula-fed newborns and subjected to stress protocol. The parameters set for the study protocol were: milk concentration (0.19 g ml or 0.34 g/ml), diet instilled volume (according to body weight - 200 kcal/day/Kg - or progressive, according to acceptance), weight (gain, loss or maintenance) and duration of the experiment (72 hours or 96 hours). Data of body weight (BW), intestinal weight (IW) and the IW/BW ratio were obtained. Samples of terminal ileum were collected and analyzed by the degree of injury to the intestinal wall. Statistically significance was set to p<0.05. RESULTS: The established protocol with less mortality and increased number of NEC was with Esbilac® at a concentration of 0.19 g/ml of diet instilled volume of 0.1 ml, every 3 hours, for 72 hours. All infants fed with artificial milk lost weight. In the degree score of intestinal injury, the ESB, IH and NEC groups were considered positive for NEC with greater histological injury in the latter. CONCLUSION: The described NEC protocol in rats allowed a greater survival of puppies with a greater number of animals affected by the disease.

OBJETIVO: Relatar as dificuldades da execução do protocolo de enterocolite necrosante (ECN) experimental a fim de obter um maior número de neonatos comprometidos com a doença e menor mortalidade. MÉTODOS: Neonatos de ratas Sprague-Dawley nascidos a termo (22 dias) foram divididos em 4 grupos de 12 fetos cada (n=48): EC - neonatos amamentados pela mãe; IH - neonatos amamentados pela mãe e submetidos a estresse por isquemia e hipotermia, ESB - neonatos alimentados por leite artificial (Esbilac®, PetAg, Hampshire, IL, USA) e NEC - neonatos alimentados com fórmula e submetidos a protocolo de estresse. Os parâmetros estabelecidos para o protocolo de estudo foram: concentração do leite (0,19 g/ml ou 0,34 g/ml), volume de dieta instilada (de acordo com ganho de peso - 200 kcal/dia/kg - ou progressivo, de acordo com aceitação), peso (ganho, perda ou manutenção) e duração do experimento (72 h ou 96 h). Dados de peso corporal (BW), peso intestinal (IW) e a relação IW/BW foram obtidos. Amostras de íleo terminal foram coletadas e analisadas pelo grau de lesão da parede intestinal. Os dados foram analisados estatisticamente com p <0,05. RESULTADOS: O protocolo estabelecido com menor mortalidade e maior número de ECN foi com Esbilac® na concentração de 0,19 g/ml, volume de dieta instilada de 0,1ml, a cada 3 horas, durante 72 horas. Todos os neonatos alimentados com leite artificial perderam peso. Na escala do grau de lesão, os grupos ESB, IH e NEC foram considerados positivos para NEC com maior lesão histológica no último. CONCLUSÃO: O protocolo de NEC experimental em ratos estabelecido possibilitou uma maior sobrevivência dos neonatos com o maior numero de animais acometidos pela doença.

Factores de riesgo asociados a mayor mortalidad en pacientes con enterocolitis necrotizante en la Unidad de Cuidados Críticos del Neonato del Hospital Nacional Docente Madre Niño San Bartolomé de Junio 2007 hasta Junio 2009, Lima-Perú / Risk factors associated with increased mortality in patients with necrotizing enterocolitis in the Critical Care Unit of the Neonate at the Teaching Hospital Mother Child San Bartolome from June 2007 to June 2009, Lima-Peru

INTRODUCCION: La enterocolitis necrotizante (ECN) a pesar del avance en el cuidado intensivo neonatal, persiste como una enfermedad grave y devastadora encontradas en la unidad de cuidados intensivos, que afecta al 5 a 10 por ciento de recién nacidos prematuros que tienen un peso al nacer menor a 1500 g y aproximadamente un tercio de ellos sucumbirá a la enfermedad. El aumento de la incidencia de NEC en las últimas décadas puede ser atribuido a los avances en la atención perinatal, que han permitido la sobrevida a recién nacidos prematuros el tiempo suficiente para desarrollar ECN. OBJETIVOS: El objetivo de este estudio fue determinar factores de riesgo asociados a mayor mortalidad en pacientes con enterocolitis necrotizante en el Hospital Nacional Docente Madre Niño San Bartolomé, junio 2007-junio 2009. MATERIAL y METODOS: Se realizó un estudio de tipo comparativo, retrospectivo y analítico, cuya población de estudio estuvo conformada por 30 neonatos nacidos en el HSB, a quienes se le realizo este diagnóstico durante su estancia en la Unidad de Cuidados críticos del Neonato en el periodo del 2007 y 2009, con la finalidad de conocer los factores de riesgo asociados a mayor mortalidad en pacientes con ECN. Se realizo un análisis descriptivo de las variables, tablas de contingencia y se aplicó la prueba de chi-cuadrado para medir la fuerza de asociación .Se determinó la media de las variables cuantitativas y se comparó la media con la prueba T de Student para grupos independientes. RESULTADOS: Se observó que los factores que incrementaron la mortalidad en los niños con NEC y que mostraron estar asociados estadísticamente fueron: el uso inotrópicos (p=0.001), de Bicarbonato de Sodio (p=0.02); y la transfusión de hemoderivados. Así mismo la mortalidad en ECN se vio incrementada en los niños que presentaban mayor grado de acuerdo a la clasificación de Bell, siendo el NEC IIIB el grupo con mayor porcentaje de fallecidos. (p=0.0001). El tratamiento quirúrgico mostró...

Necrotizing enterocolitis: a comparison between full-term and pre-term neonates.

A retrospective study comparing 16 full-term and 18 pre-term neonates with NEC operated on at Siriraj Hospital between 1987 and 1999 is presented. Major risk factors leading to NEC in full-term neonates included sepsis, SGA, birth asphyxia, severe jaundice requiring exchange transfusion and chorioamnionitis. Although full-term neonates developed NEC earlier than pre-term neonates (8.56 days vs 12.78 days), the average ages of operation in both groups were the same. There was no difference in CBC and bacteriological culture's results between term and pre-term patients. The decision to conduct operative treatments for full-term neonates with NEC was mostly based on only clinical signs of peritonitis (56.25%) before the pneumoperitoneum developed (31.25%). Ileo-caecal region was the most common site of bowel necrosis in both premature and full-term infants. Although term infants had a better 3-month survival rate than pre-term neonates (75% and 61% respectively), both groups had the same surgical complication rates.

Factores relacionados con mortalidad en enterocolitis necrosante neonatal y del lactante / Factors related to mortality in necrotizing enterocolitis (NEC) in neonates and older infants

Con el objeto de evaluar algunos factores que pudieran estar relacionados a mortalidad en Enterocolitis Necrosante (ECN), se revisaron retrospectivamente las Historias Clínicas de neonatos y lactantes diagnosticados de ECN en el Instituto de Salud del Niño (ISN), entre los años 1984 y 1993. Se incluyeron en el estudio sólo aquellos casos con confirmación radiológica, quirúrgica y/o anatomopatológica. Se encontraron untotal de 60 casos (46 lactantes y 14 neonatos), con una mayor incidencia en varones (37 varones y 23 mujeres). En 26 casos se requirió manejo quirúrgico. La mortalidad fue de 77 por ciento, sin encontrarse diferencia significativa entre lactantes y neonatos y entreoperados y no operados. Se encontraron como factores relacionados a la mortalidad, desnutrición moderada-severa, presencia de diarrea al inicio del cuadro clínico, bronconeumonía concomitante con la enfermedad, shock y al mal manejo nutricional (no uso de soporte nutricional con Nutrición Parenteral Total).

In order to determine the factors related to mortality in Necrotizing enterocolitis (NEC), medical records of neonates and older infants diagnosed of NEC in the Instituto de Salud del Niño between 1984 and 1993 were retrospectively reviewed. Only the cases with a reliable roentgenologic, surgical or pathologic diagnosis were included. Sixty cases (46 infants and 14 neonates) were found, with a higher incidence in males (37 males vs 23 females). Twenty six cases requiered surgical treatment. Overall mortality was 77 per cent, with no significant differences between neonates and infants, nor betweenthose who were operated or not. Moderate or severe malnutrition, diarrohea as an early clinical manifestations, bronchopneumonia, shock and poor nutricional managementwere found as factors related to mortality.