Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review

Battersby et al, Arch Dis Child Fetal Neonatal Ed. 2018 Jan


The early survival of preterm babies has increased in high-resource settings, and as a consequence, the number at risk of serious complications that commonly occur in the neonatal period, such as necrotising enterocolitis (NEC), is increasing. NEC is now one of the leading causes of mortality and morbidity in neonatal intensive care.The poor understanding of its aetiology and pathophysiology and absence of a non-invasive diagnostic test have resulted in a lack of clarity of what constitutes ‘NEC’. Recent reports from the USA describe a fall in NEC incidence despite a rising preterm term birth rate. Understanding variation between different populations and over time in the incidence of this serious gastrointestinal disease is important in identifying determinants, designing preventive trials and implementing quality improvement programmes. Little is known of international variation in disease burden. The aim of this study was to review systematically and summarise published data that most closely describe the national incidence of NEC in high-income countries.


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.