Epidemiology of Necrotizing Enterocolitis Temporal Clustering in Two Neonatology Practices

Objective

To develop a statistical method for defining clusters of necrotizing enterocolitis (NEC) cases in the neonatal intensive care unit (NICU).

Study design

The study group included 2782 infants weighing 401 to 1500 g at birth born between 1996 and 2004. NEC was defined as Bell stage II or III. Two statistical methods were used to define “disease clusters”: a modified scan test and a comparison of observed and expected incidence density rates (IDRs) of NEC at each NICU.

Results

The proportion of infants with NEC was similar in the 2 NICUs (7.1% vs 7.7%; P = .6), as was the expected IDR of NEC (1.39/1000 patient-days vs 1.32/1000 patient-days; P = .72). Twelve temporal clusters of NEC were identified in the 2 NICUs, representing 18% of 203 total NEC cases during the study period. No seasonal/secular trends were noted for NEC rates or identified clusters. Potential NEC clusters of ≥3 cases at either NICU had a >75% likelihood of being a true NEC cluster.

Conclusions

No operational definition of NEC cluster exists. This study introduces methods to use in prospective surveillance and to guide studies investigating etiologic relevance. Using the proposed methods, statistically significant clusters (ie, potential outbreaks) of NEC within NICUs can be identified early, providing an opportunity for early implementation of cluster investigation protocols.

Abbreviations: CI, Confidence interval, ELBW, Extremely low birth weight, IDR, Incidence density rate, NEC, Necrotizing enterocolitis, NICHD, National Institute of Child Health and Human Development, NICU, Neonatal intensive care unit, SD, Standard deviation, VLBW, Very low birth weight