Multicenter cohort of necrotizing enterocolitis in Latin America: evaluation of risk factors and clinical outcomes in Chilean Hospitals.
8 affiliations
- 1Hospital Carlos Van Buren, Valparaíso, Chile.
- 2Departamento de Pediatría, Universidad de Valparaíso, Valparaíso, Chile.
- 3Hospital Clínico San Borja-Arriarán, Santiago, Chile.
- 4Facultad de Medicina, Universidad de Chile, Santiago, Chile.
- 5Servicio de Neonatología, Clínica Alemana, Santiago, Chile.
- 6Hospital Sótero del Río, Santiago, Chile.
- 7Servicio de Neonatología, Hospital Sótero del Río, Santiago, Chile.
- 8Instituto de Tecnología Para la Innovación en Salud y Bienestar (ITiSB)-UNAB, Viña del Mar, Chile.
Abstract
Necrotizing enterocolitis (NEC) remains a leading cause of neonatal morbidity. While risk factors are well documented in high-income countries, data from Latin American cohorts remain limited. We aimed to identify local predictors and clinical outcomes associated with NEC in two Chilean NICUs. A prospective multicenter cohort study (2017-2018) included newborns ≤32 weeks and/or ≤1,500 g. NEC (Bell stage ≥ IIA) was verified by a multidisciplinary team. Clinical and laboratory variables were analyzed using bivariate and multivariable penalized models to identify predictors of NEC and mortality. Among 177 newborns (mean GA 29.1 ± 3.0 weeks; BW 1,252 ± 448 g), NEC incidence was 7.9% (n = 14). In bivariate analysis, invasive mechanical ventilation (RR = 4.58; p = 0.02) and indomethacin (RR = 3.13; p = 0.04) were associated with NEC. In multivariable models, formula feeding was the most consistent predictor (OR = 2.69 vs. exclusive breast milk), though not statistically significant. Half of NEC cases (50%) were Bell stage IIIB. Surgery was required in 38.5% of cases (all stage IIIB; p = 0.009). Case fatality among NEC patients was 40%, associated with Bell stage IIIB (p = 0.048) and systemic shock (p = 0.048). Formula feeding was a consistent, though non-significant, predictor of NEC in multivariable analysis; the limited number of NEC cases (n = 14) precludes definitive causal inference. Exclusive breastfeeding remained the most protective feeding strategy, consistent with prior literature. Disease outcomes were driven by progression to Bell stage IIIB, and early monitoring of inflammatory and metabolic biomarkers may help identify infants at risk of progression to surgical NEC.
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BibTeX
@article{sandoval2026multicenter,
title = {{Multicenter cohort of necrotizing enterocolitis in Latin America: evaluation of risk factors and clinical outcomes in Chilean Hospitals.}},
author = {Alejandra Sandoval C and Luis Delpiano M and Miguel Ángel Pantoja H and Marta Aravena U and Jeanne Smith R and Hector Pérez A and Sebastian Espinoza E},
journal = {Frontiers in pediatrics},
year = {2026},
month = oct,
doi = {10.3389/fped.2026.1877057},
url = {https://europepmc.org/article/MED/42952806},
note = {CC BY},
}
RIS
TY - JOUR
TI - Multicenter cohort of necrotizing enterocolitis in Latin America: evaluation of risk factors and clinical outcomes in Chilean Hospitals.
AU - Alejandra Sandoval C
AU - Luis Delpiano M
AU - Miguel Ángel Pantoja H
AU - Marta Aravena U
AU - Jeanne Smith R
AU - Hector Pérez A
AU - Sebastian Espinoza E
PY - 2026
DA - 2026/10/14
JO - Frontiers in pediatrics
DO - 10.3389/fped.2026.1877057
UR - https://europepmc.org/article/MED/42952806
AB - Necrotizing enterocolitis (NEC) remains a leading cause of neonatal morbidity. While risk factors are well documented in high-income countries, data from Latin American cohorts remain limited. We aimed to identify local predictors and clinical outcomes associated with NEC in two Chilean NICUs. A prospective multicenter cohort study (2017-2018) included newborns ≤32 weeks and/or ≤1,500 g. NEC (Bell stage ≥ IIA) was verified by a multidisciplinary team. Clinical and laboratory variables were analyzed using bivariate and multivariable penalized models to identify predictors of NEC and mortality. Among 177 newborns (mean GA 29.1 ± 3.0 weeks; BW 1,252 ± 448 g), NEC incidence was 7.9% (n = 14). In bivariate analysis, invasive mechanical ventilation (RR = 4.58; p = 0.02) and indomethacin (RR = 3.13; p = 0.04) were associated with NEC. In multivariable models, formula feeding was the most consistent predictor (OR = 2.69 vs. exclusive breast milk), though not statistically significant. Half of NEC cases (50%) were Bell stage IIIB. Surgery was required in 38.5% of cases (all stage IIIB; p = 0.009). Case fatality among NEC patients was 40%, associated with Bell stage IIIB (p = 0.048) and systemic shock (p = 0.048). Formula feeding was a consistent, though non-significant, predictor of NEC in multivariable analysis; the limited number of NEC cases (n = 14) precludes definitive causal inference. Exclusive breastfeeding remained the most protective feeding strategy, consistent with prior literature. Disease outcomes were driven by progression to Bell stage IIIB, and early monitoring of inflammatory and metabolic biomarkers may help identify infants at risk of progression to surgical NEC.
SN - 2296-2360
ER -