Epidemiology of necrotizing enterocolitis temporal clustering in two neonatology practices

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In this issue of The Journal, Meinzen-Derr et al report on statistical methods for defining clusters of necrotizing enterocolitis (NEC) cases in the neonatal intensive care unit (NICU). This enigmatic disease has vexed neonatal intensivists for decades. Although there is some reasonably well accepted structure around case definition, there is a lack of precise insight into the pathophysiology. This has further precluded improvements outcome. Most clinicians have personal experience with temporal and geographic clustering of cases, however, what constitutes an “outbreak” in a specific NICU is vague. The report by Meinzen-Derr et al describes two approaches to identifying clusters. Their results debunk certain myths, like seasonal variation, in the nurseries they studied. It is hoped that these methods for prospective surveillance will guide studies of etiologic relevance, identify clusters earlier, and provide prospective opportunity to implement more effective cluster investigations. In the best case scenario, such focused attention on this low incidence but high impact problem will lead to improved opportunities for targeted patient enrollment in prospective studies. Investigators contemplating some of the newer immunologically directed therapies will be aided in their surveillance efforts by these methods.