Factores de riesgo que involucran el desarrollo de enterocolitis necrotizante en recién nacidos pretérmino con peso menor a 1500 gramos en el Hospital Roberto Gilbert Elizalde periodo 2018-2019.

Abstract

Introduction: Necrotizing enterocolitis is one of the most serious pathologies that occurs in the neonatal period, predominantly affects premature newborns with very low birth weight. The pathogenesis has been related to the interaction of multiple risk factors that include prematurity, low weight, hypoxic-ischemic phenomena, sepsis, type of diet, use of antibiotics, blood transfusions, among others, but prematurity is the only factor identified with statistical significance. Objective: To determine the risk factors that involve the development of necrotizing enterocolitis in preterm newborns weighing less than 1500 grams admitted to the Roberto Gilbert Elizalde Hospital in the 2018-2019 period. Materials and Methods: A retrospective analytical observational study of cases and controls was carried out, in which all preterm infants, weighing less than 1500 grams (n = 313), treated at the Roberto Gilbert Elizalde Hospital between 2018 and 2019 were identified. Information was obtained on diagnosis and procedures performed in the postnatal period and a statistical analysis with logistic regression was performed to determine the most significant risk factors associated with NEC. Results: In this work, 313 patients were studied, who met the inclusion criteria, of which 161 developed NEC. Positive associations were found between necrotizing enterocolitis and risk factors such as: umbilical catheterization, demonstrated in the binary logistic regression analysis OR 5.20 95% CI (1.95-9.14), percutaneous catheterization with access through the saphenous vein showed a risk correlation for NEC OR 4.50 95% CI (2.45-8.29) p = 0.0001; anemia (but not transfusion) was significantly related to the probability of developing NEC OR 1.59 95% CI (1.01-2.5) p = 0.04; as well as feeding with formula milk with an OR 2.01 95% CI (1.23-3.29) p = 0.005 and the presence of ductus with a risk OR 2.03; while mechanical ventilation was shown to increase the risk of NEC, but without statistical significance. In contrast, gender, being small for gestational age, being born by cesarean section, asphyxia, and sepsis were not significant risk factors. In contrast, the use of vasopressor amines and the administration of breast milk were shown to be a protective factor. Conclusions: The results of this study support that the development of NEC in premature infants is a consequence of potentially modifiable factors such as the use of vascular accesses, including umbilical and percutaneous catheterization with access through the saphenous vein, the use of formula milk, the amount administered and the day of initiation of feeding, as well as comorbidities typical of the neonate such as anemia and persistence of the ductus arteriosus.