Epidemiology of necrotizing enterocolitis in preterm infants in China: A multicenter cohort study from 2015 to 2018

Purpose: To describe the current incidence, case-fatality rate and surgical treatment proportion of necrotizing enterocolitis (NEC) among preterm infants in China. Methods: The study included all live neonates with < 34 weeks gestational age (GA) admitted to 25 tertiary hospitals within 7 days of birth from 19 provinces in China between May 2015 and April 2018. NEC was defined as >stage II according to Bell's criteria. Results: A total of 24,731 infants were included. The overall incidence of NEC was 3.3% and decreased with increasing GA and birth weight. The incidence of NEC was 4.8% in very preterm infants and 1.8% in infants born >32 weeks GA, respectively. The overall case-fatality rate of NEC was 9.5%, and the case fatality rate was 7.0% among infants born >32 weeks GA. A total of 214 (27.9%) infants underwent surgery, and their overall case-fatality rate was 13.6%. Significant variation in the incidence of NEC existed among different centers (0.6-11.1%). Conclusions: The incidence and case-fatality rate of NEC are high in China, especially among infants with GA >32 weeks, and varies significantly among sites. A high proportion of NEC infants required surgical management, with an even higher case-fatality rate. (c) 2021 Elsevier Inc. All rights reserved.