In the latest issue of Acta Paediatrica there is a short communication from
some neonatologists in Tampere, Finland.
Hällström M, Koivisto A-m, Janas M, Tammela O. Frequency of and risk factors
for necrotizing enterocolitis in infants born before 33 weeks of gestation.
Acta Paediatr 2003;92: 111-113. Stockholm. ISSN 0803-5253

"Aim: to investigate the frequency of and risk factors for necrotizing
enterocolitis (NEC) among infants of <33 wk of gestation.  Methods:
Prospective follow-up of 140 inpatients. Results: 26 (18.6%) subjects
developed NEC stage I-III and 12 (8.6%) severe NEC (stage II-III).  Breast
milk fortifier and duration of morphine infusion emerged as the statistically
significant factors associated with NEC stage I-III, but only the latter had a
significant association with severe NEC."

O.Tammela, the final author, may be contacted at [log in to unmask]

I read the whole article and it is apparent that the babies who got NEC were
the ones already at highest risk; they were younger and smaller than the
under-33-weekers who didn't get NEC.  Their size was also what determined that
they got human milk fortifier.  They were less stable from birth, and had a
longer time lag from birth to oral feedings than the larger, more stable
infants in the non-NEC group. Three babies with NEC died, all of NEC.  But
even in the non-NEC group there were 19 deaths out of 114 patients, which
underscores previous posts pointing out that this group of babies is very
vulnerable.  Morphine was given to all babies on ventilators for 'pain relief
and sedation' and the authors wonder whether it is the effect on gut motility
which increases the risk of NEC.  They call for future studies to examine
whether morphine is a causative factor.

Rachel Myr
Norway

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