283 COMPARISON OF OUTCOMES OF INFANTS WITH NECROTIZING ENTEROCOLITIS OR SPONTANEOUS INTESTINAL PERFORATION IN THE NEONATAL INTENSIVE CARE UNIT (1999-2003)

PurposeTo determine incidence and outcomes of necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) during a recent 5 year period.MethodsThis was a retrospective chart review of admissions to the neonatal intensive care units (NICU) of Kosair Children's Hospital and University of Louisville Hospital from 1/1/99-12/31/03 with the diagnosis of either NEC or SIP. Cases were identified by ICD-9 codes and confirmed by chart review. During the 3 days prior to and after diagnosis (total 7 days), data reflecting general medical condition, feeding history, medications and indicators of infection (positive blood cultures, white blood cell [WBC] counts, blood pH) were recorded.ResultsThere were 74 cases of NEC and 35 cases of SIP. Birth weight (BW) and gestational age (GA) were similar between groups. Infants with SIP had lower 5-minute Apgar scores (6 ± 3 vs. 7 ± 2, p = .003). While the cohorts were predominantly preterm, ˜ 5.5% of infants in each group were ≥ 38 weeks GA (term). Ninety-three percent of infants with NEC were fed a mean of 15 days prior to diagnosis, while 69% of infants with SIP were never fed (p < .001). Infants with NEC were ˜ 3 weeks of age at diagnosis while infants with SIP were ˜ 9 days (p < .001).The use of umbilical artery (UAC, 74% vs. 41%, p = .002) and umbilical venous catheters (UVC, 97 vs. 70%, p = .019) was significantly higher in the SIP group, although the duration of use was not significantly different. WBC and blood pH were not helpful in predicting onset of illness, although there was a trend for pH to be lower in SIP infants. By the day of diagnosis (day 0), absolute neutrophil counts (ANC) were significantly higher in infants with SIP (p < .015). Throughout the 7-day study period, platelet counts in SIP infants remained significantly lower (but within normal limits) than in infants with NEC (p < .012) despite the use of platelet transfusions. Weight and GA at discharge were similar in the two groups, as was survival.ConclusionsEnteral feeding prior to diagnosis was more common in NEC than in SIP. In-dwelling umbilical catheters were more commonly associated with SIP. Laboratory differences in the 72 hours prior to diagnosis included higher ANC and lower platelet counts in infants with SIP. Mortality was not different between groups.