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Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review
  1. Cheryl Battersby1,
  2. Tharsika Santhalingam2,
  3. Kate Costeloe3,
  4. Neena Modi1
  1. 1 Department of Medicine, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Chelsea and Westminster campus, Imperial College London, London, UK
  2. 2 King’s College London, London, UK
  3. 3 Barts and the London School of Medicine and Dentistry, London, UK
  1. Correspondence to Dr Cheryl Battersby, Department of Medicine, Section of Neonatal Medicine, Imperial College London Chelsea and Westminster campus, London SW10 9NH, UK; c.battersby{at}


Objective To conduct a systematic review of neonatal necrotising enterocolitis (NEC) rates in high-income countries published in peer-reviewed journals.

Methods We searched MEDLINE, Embase and PubMed databases for observational studies published in peer-reviewed journals. We selected studies reporting national, regional or multicentre rates of NEC in 34 Organisation for Economic Co-operation and Development countries. Two investigators independently screened studies against predetermined criteria. For included studies, we extracted country, year of publication in peer-reviewed journal, study time period, study population inclusion and exclusion criteria, case definition, gestation or birth weight-specific NEC and mortality rates.

Results Of the 1888 references identified, 120 full manuscripts were reviewed, 33 studies met inclusion criteria, 14 studies with the most recent data from 12 countries were included in the final analysis. We identified an almost fourfold difference, from 2% to 7%, in the rate of NEC among babies born <32 weeks’ gestation and an almost fivefold difference, from 5% to 22%, among those with a birth weight <1000 g but few studies covered the entire at-risk population. The most commonly applied definition was Bell’s stage ≥2, which was used in seven studies. Other definitions included Bell’s stage 1–3, definitions from the Centers for Disease Control and Prevention, International Classification for Diseases and combinations of clinical and radiological signs as specified by study authors.

Conclusion The reasons for international variation in NEC incidence are an important area for future research. Reliable inferences require clarity in defining population coverage and consistency in the case definition applied.

PROSPERO International prospective register of systematic reviews registration number CRD42015030046.

  • necrotising enterocolitis
  • incidence
  • high-income
  • preterm
  • babies

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  • Contributors CB conceptualised and designed the study and data collection forms, performed the initial searches, extracted the data, drafted the initial manuscript and approved the final manuscript as submitted. TS carried out the initial searches and extracted the data independently, reviewed and revised the manuscript and approved the final manuscript as submitted. KC critically reviewed the manuscript, contributed to each draft and approved the final manuscript as submitted. NM critically reviewed the manuscript and approved the final manuscript as submitted.

  • Funding This paper represents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research (Grant Reference Number RP-PG-0707-10010).

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.