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Background <p>Whether early-onset (EO-NEC) and late-onset necrotizing enterocolitis (LO-NEC) represent distinct entities remains debated. We compared clinical presentation, radiologic features, and surgical outcomes.</p> Methods <p>In this retrospective study (2013–2023), neonates with Bell stage II–III NEC were stratified into EO-NEC (&lt; 14 days) and LO-NEC (≥ 14 days).</p> Results <p>Fifty-seven infants were included: 37 (64.9%) EO-NEC and 20 (35.1%) LO-NEC. EO-NEC was associated with higher birth weight (1611 ± 767 vs. 1111 ± 377&#xa0;g; <i>p</i> = 0.0017) and gestational age (31.4 ± 4.5 vs. 29.3 ± 2.7 weeks; <i>p</i> = 0.033). LO-NEC occurred more frequently in very-low-birth-weight infants (55% vs. 8%; <i>p</i> &lt; 0.001) and showed higher rates of portal venous gas (70% vs. 30%; <i>p</i> = 0.005) and indomethacin-treated PDA (25% vs. 2.7%; <i>p</i> = 0.031). Intestinal perforation occurred exclusively in EO-NEC (27%; <i>p</i> = 0.01). Surgical intervention rates, intestinal resection lengths, and mortality were comparable.</p> Conclusions <p>EO-NEC and LO-NEC differ in infant maturity and perinatal exposures but not in overall severity or mortality.</p>

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Two faces of necrotizing enterocolitis: early and late-onset disease in preterm infants

  • 期刊论文

  • 发表日期：

    2026年5月4日

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  • Donatella Di Fabrizio,
  • Edoardo Bindi,
  • Ilaria Acquaviva,
  • Irene Tavolario,
  • Ilaria Burattini,
  • Alba Cruccetti,
  • Giovanni Cobellis

摘要

Background

Whether early-onset (EO-NEC) and late-onset necrotizing enterocolitis (LO-NEC) represent distinct entities remains debated. We compared clinical presentation, radiologic features, and surgical outcomes.

Methods

In this retrospective study (2013–2023), neonates with Bell stage II–III NEC were stratified into EO-NEC (< 14 days) and LO-NEC (≥ 14 days).

Results

Fifty-seven infants were included: 37 (64.9%) EO-NEC and 20 (35.1%) LO-NEC. EO-NEC was associated with higher birth weight (1611 ± 767 vs. 1111 ± 377 g; p = 0.0017) and gestational age (31.4 ± 4.5 vs. 29.3 ± 2.7 weeks; p = 0.033). LO-NEC occurred more frequently in very-low-birth-weight infants (55% vs. 8%; p < 0.001) and showed higher rates of portal venous gas (70% vs. 30%; p = 0.005) and indomethacin-treated PDA (25% vs. 2.7%; p = 0.031). Intestinal perforation occurred exclusively in EO-NEC (27%; p = 0.01). Surgical intervention rates, intestinal resection lengths, and mortality were comparable.

Conclusions

EO-NEC and LO-NEC differ in infant maturity and perinatal exposures but not in overall severity or mortality.