Neonatal necrotizing enterocolitis significantly increases sepsis risk and worsens clinical outcomes: a 1:1 matched case-control study

Neonatal necrotizing enterocolitis (NEC) is a leading cause of death in neonates, especially in preterm infants. Sepsis is a common and severe complication after NEC onset. This study aims to evaluate the characteristics of sepsis development in NEC patients and to explore the association between sepsis and clinical outcomes of NEC.

This case-control study enrolled 178 neonates diagnosed with NEC admitted in our hospital from April 2022 to December 2023, who were matched 1:1 with 178 non-NEC controls by birth weight, gestational age, and sex. All neonates were grouped according to the presence or absence of sepsis. Univariate analysis and stepwise-adjusted multivariate logistic regression were used to analyze risk factors for sepsis. The impact of sepsis on clinical outcomes in NEC patients was analyzed.

The NEC group exhibited significantly older maternal gestational age (P<0.001) and a higher prevalence of congenital heart disease (P<0.02) compared with the control group. Among the 356 neonates, 120 developed sepsis. Univariate analysis indicated that younger gestational age, lower birth weight, 5-minute Apgar score≤7, and NEC were potentially associated with sepsis (all P<0.05). Univariate logistic regression analysis showed that NEC was a risk factor for sepsis (OR=2.042, 95%CI: 1.307 to 3.213, P=0.002). Stepwise-adjusted multivariate logistic regression analysis showed that after adjusting for gestational age, birth weight, and 5-min Apgar score, NEC remained a significant risk factor for sepsis (OR=2.141, 95%CI: 1.345 to 3.436, P=0.001). Among the NEC neonates, those with sepsis had a significantly higher surgical rate (52.70% vs 14.42%, P<0.001) and an increased mortality rate (22.97% vs 6.73%, P=0.002) than those without sepsis.

NEC significantly increases the risk of sepsis and leads to more adverse clinical outcomes. These findings suggest that NEC patients may require enhanced early identification and monitoring of sepsis to improve their clinical outcomes.