Necrotizing Enterocolitis among Very Low Birthweight Neonates: A Systematic Review and Meta-Analysis

Objective: Necrotizing enterocolitis (NEC) is a critical gastrointestinal disorder that primarily affects very low birthweight (VLBW) neonates. Enhancing neonatal care requires a thorough understanding of the incidence, risk factors, and outcomes associated with NEC. This systematic review and meta-analysis aim to consolidate and analyze existing literature to provide a comprehensive overview of NEC among VLBW neonates. Methods: A systematic search of relevant studies was conducted, resulting in the inclusion of 15 studies encompassing a total of 259,500 infants from diverse populations and regions. Pooled estimates of NEC incidence were calculated using a random- effects model. Additionally, factors contributing to NEC incidence and their consistency across studies were explored. Results: The meta-analysis yielded a pooled estimate of NEC incidence among VLBW neonates at approximately 6.62% (95% CI: 5.33% to 7.90%). Notably, significant heterogeneity was observed among the included studies (I2 2 = 100%), reflecting the multifaceted nature of NEC. Qualitative data synthesis revealed that lower birth weight, gestational age, maternal age, intrapartum antibiotics, racial disparities, chorioamnionitis, healthcare-associated sepsis, and antenatal steroids were consistently associated with NEC risk, aligning with existing literature. Conclusion: This systematic review and meta-analysis provide a comprehensive overview of NEC among VLBW neonates, underscoring the imperative for evidence-based interventions aimed at reducing NEC incidence and improving outcomes for this vulnerable population. Insight into the intricate complexities of NEC and its associated risk factors is crucial for guiding clinical practice and informing future research endeavors