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Parvesh Mohan Garg1✉, Jaslyn L. Paschal1, Md Abu Yusuf Ansari2, Danielle Block1, Kengo Inagaki3 and Jörn-Hendrik Weitkamp4. Clinical impact of NEC-associated sepsis on outcomes in preterm infants. Mar 2022. Pediatric Research.

OBJECTIVE: To determine risk factors and outcomes of necrotizing enterocolitis (NEC)-associated sepsis in infants with NEC.

 METHODS: A retrospective review comparing demographic and clinical information in infants with and without NEC-associated sepsis (defined as positive blood culture at the time of NEC onset).

RESULTS: A total of 209 infants with medical (n = 98) and surgical NEC (n = 111) had a median gestational age of 27 weeks (IQR 25; 30.5) and a median birth weight of 910 g [IQR 655; 1138]. Fifty of 209 (23.9%) infants had NEC-associated sepsis. Infants with NECassociated sepsis had lower median GA (26.4 vs. 27.4 weeks; p = 0.01), lower birth weight (745 vs. 930 g; p = 0.009), were more likely mechanically ventilated [p < 0.001], received dopamine [p < 0.001], had more evidence of acute kidney injury [60% vs. 38.4%, p = 0.01], longer postoperative ileus (16 [13.0; 22.0] vs. 12 [8; 16] days; p = 0.006), higher levels of C-reactive protein, lower platelet counts, longer hospitalization compared to infants without NEC-associated sepsis. On multivariate regression, cholestasis was an independent risk factor for NEC-associated sepsis (OR 2.94; 95% CI 1.1–8.8, p = 0.038).

CONCLUSION: NEC-associated sepsis was associated with greater hemodynamic support, acute kidney injury, longer postoperative ileus, and hospitalization on bivariate analysis, and cholestasis was associated with higher odds of sepsis on multi regression analysis.

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