Peer-reviewed article
Global incidence of Necrotizing Enterocolitis: a systematic review and Meta-analysis
Amer Alsaied, Nazmul Islam, Lukman Thalib ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review and meta-analysis examined the global incidence of necrotizing enterocolitis (NEC), a serious condition affecting newborns in intensive care units. The researchers pooled data from 27 cohort studies covering 574,692 infants, finding that approximately 7 out of 100 very low birth weight infants in neonatal intensive care units develop NEC. The study found substantial variation between studies and some differences between high and low-income countries, with NEC rates increasing over time.
Key points
- 39,965 infants out of 574,692 studied developed NEC
- Pooled global incidence estimate of NEC is 7.0% (95% CI: 6.0–8.0%) among very low birth weight infants
- NEC rates show statistically significant increase over time based on publication year
- Some variation in NEC estimates noted between high and low-income countries
- Substantial heterogeneity between studies with I² = 100%
Limitations
The review identifies substantial heterogeneity between the included studies, which limits confidence in comparing incidence across different settings. The document does not evaluate specific interventions or risk factors that might reduce NEC incidence, nor does it provide detailed analysis of the causes behind the variation between countries and over time.
Abstract
Abstract Background Necrotizing Enterocolitis (NEC) is a major cause of morbidity and mortality in the Neonatal Intensive Care Unit (NICU), yet the global incidence of NEC has not been systematically evaluated. We conducted a systematic review and meta-analysis of cohort studies reporting the incidence of NEC in infants with Very Low Birth Weight (VLBW). Methods The databases searched included PubMed, MEDLINE, the Cochrane Library, EMBASE and grey literature. Eligible studies were cohort or population-based studies of newborns including registry data reporting incidence of NEC. Incidence were pooled using Random Effect Models (REM), in the presence of substantial heterogeneity. Additional, bias adjusted Quality Effect Models (QEM) were used to get sensitivity estimates. Subgroup analysis and meta-regression were used to explore the sources of heterogeneity. Funnel plots as appropriate for ratio measures were used to assess publication bias. Results A systematic and comprehensive search of databases identified 27 cohort studies reporting the incidence of NEC. The number of neonate included in these studies was 574,692. Of this 39,965 developed NEC. There were substantial heterogeneity between studies (I 2 = 100%). The pooled estimate of NEC based on REM was 7.0% (95% CI: 6.0–8.0%). QEM based estimate (6.0%; 95% CI: 4.0–9.0%) were also similar. Funnel plots showed no evidence of publication bias. Although, NEC estimates are similar across various regions, some variation between high and low income countries were noted. Meta regression findings showed a statistically significant increase of NEC over time, quantified by the publication year. Conclusion Seven out of 100 of all VLBW infants in NICU are likely to develop NEC. However, there were considerable heterogeneity between studies. High quality studies assessing incidence of NEC along with associated risk factors are warranted.