Abstract

Objective: Necrotizing enterocolitis (NEC) remains a major cause of morbidity and mortality in extremely preterm infants. This study aimed to determine the incidence of NEC, identify antenatal, perinatal, and postnatal risk factors, and evaluate predictors of disease severity and mortality in infants born at ≤32 weeks’ gestation.

Materials and Methods: In this retrospective single-center study, 1509 preterm infants admitted to the NICU of Ankara Bilkent City Hospital between 2019 and 2024 were reviewed. Infants with stage II–III NEC (n=109) were compared with gestational age matched controls (n=252). Clinical variables, including feeding characteristics, laboratory markers, complications, and outcomes were analyzed using logistic regression and ROC analysis.

Results: NEC was strongly associated with lower gestational age, birth weight <1000 g, low APGAR scores, need for resuscitation, umbilical catheterization, PDA, transfusion, and delayed initiation of enteral feeding (all p<0.001). Human milk fortifier use was associated with reduced NEC risk. Late onset sepsis, metabolic acidosis, anemia, intracranial hemorrhage, and inotrope use independently predicted advanced stage NEC. Pre diagnostic IL 6 levels were higher in stage III NEC. Gestational age ≤29.5 weeks and birth weight ≤1235 g were moderate predictors of severe NEC. Stage III NEC was associated with significantly higher complication and mortality rates.

Conclusion: Extreme prematurity, hemodynamic instability, delayed feeding, and inflammatory activation are major determinants of NEC severity and mortality. Early risk stratification and optimized feeding strategies may reduce NEC related morbidity and mortality.

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Copyright © 2026 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Deda İnce N, Tayman C, İnce YE. Incidence of necrotizing enterocolitis and predisposing factors in extremely preterm infants: A single-center experience. Turk J Pediatr Dis. 2026;Early View:1-7. https://doi.org/10.12956/TJPD.2026.1324