Necrotizing enterocolitis in the first 24 hours of life

Necrotizing enterocolitis (NEC) is commonly thought of as occurring in the sick premature infant, usually in the first one to two weeks of life. A review of NEC at the Children's Hospital of Denver over a 5-year period, found that 13 of 79 infants (16.1%) had onset of NEC during the first day of life. These infants were larger (mean birth weight 2,624 +/- 849 g), more mature (mean gestational age 37.9 +/- 2.5 weeks), and less asphyxiated as judged by Apgar scores (mean five-minute score 8.15 +/- 1.07) than infants with onset of NEC after the first day of life (mean birth weight 1,519 +/- 586 g, mean gestational age 32.0 +/- 3.5 weeks, P less than .001, and mean five-minute Apgar score 6.81 +/- 1.84, P less than .05). Despite their large size and degree of maturity, eight of these infants (62%) showed signs of respiratory distress; four (31%) were polycythemic; four (31%) had either a partial or double-volume exchange transfusion performed; and 11 (85%) were fed prior to developing NEC. Presenting signs of disease, occurrence of sepsis (31%), requirement for surgical intervention (62%), and mortality (30%) were similar for the two groups of infants. It is suggested that term and near-term infants who have significant illness after delivery be treated more like their premature counterparts with cautious introduction of feedings after an adequate period of stabilization.