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Objective: This investigation tests the hypothesis that the clinical presentation and the outcome of necrotizing enterocolitis (NEC) vary with gestational age (GA)., Methods: All infants admitted to our center between October 1991 and September 2003 were evaluated weekly to identify confirmed cases of NEC. Based upon GA, these infants were divided into five groups: Extremely premature (EP, 23 to 26 weeks), very premature (VP, 27 to 29 weeks), moderately premature (MP, 30 to 34 weeks), near-term (NT, 35 to 36 weeks), and term (T, 37 to 42 weeks)., Results: A total of 202 infants developed NEC. The most common sign of NEC among EP infants was ileus (77%), followed by abdominal distention (71%), emesis (58%), pneumoperitoneum (54%), fixed intestinal loop (52%), gasless abdomen (42%) and bloody stools (17%). Intramural gas was detected in 100% of T but was present in only 29% of EP infants (P < 0.0001). Similarly, portal venous gas was common in T but infrequent in the EP infants (47 vs 10%, P < 0.0001). Despite a higher peritoneal drain insertion rate (31 vs 5%, P < 0.001) and a higher mortality rate (33 vs 10%, P = 0.05) in EP compared to T infants, other clinical outcomes were not different., Conclusions: The clinical presentation of NEC is different in EP compared to more mature infants; however, outcome among NEC survivors is similar across all GA. Reliance solely on observation of intramural or on portal venous gas in EP infants may lead to a delay or failure in the diagnosis.

Background:Early neonatal hypotension (ENH) is common in premature infants and has been claimed to occur more frequently in infants born to mothers with severe preeclampsia. Previous studies that showed a relationship between maternal preeclampsia and neonatal hypotension did not control for potential confounding factors such as birth weight and maternal treatment with magnesium sulfate (MgSO4).Objective:To determine whether maternal preeclampsia is an independent risk factor for ENH.Study Design:We conducted a retrospective review of all viable singleton infants with gestational age of 23 to 30 weeks who were admitted to the neonatal intensive care unit over a 2-year period. ENH was defined as the persistence of the mean arterial pressure lower than the gestational age in weeks requiring volume expansion and inotropic support in the first 24 h of life.Results:One hundred and eighty four infants were enrolled. Seventy-five (41%) infants met the diagnostic criteria for ENH. Maternal preeclampsia, the presence of labor, maternal treatment with MgSO4, Apgar scores, birth weight, gestational age and respiratory distress syndrome were significantly associated with ENH by univariate analysis. Only gestational age and maternal preeclampsia were significantly associated with ENH by multiple logistic regression.Conclusion:Gestational age and maternal preeclampsia were independent risk factors for ENH in our population of premature infants.Journal of Perinatology (2006) 26, 471–475. doi:10.1038/sj.jp.7211558; published online 15 June 2006 [ABSTRACT FROM AUTHOR]