Journal of pediatric surgery · 2026
Epidemiology of necrotizing enterocolitis in multi-birth preterm infants: A 22-year retrospective study in Switzerland (2000-2021).
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Milosevic Milan, Stalder Tim, Haefeli Stephanie, Kidszun Andre, Krause Tobias, Starvaggi Carl, Berger Steffen, Adams Mark, Kessler Ulf, Swiss Neonatal Network
Аннотация
BACKGROUND: Necrotizing enterocolitis (NEC) is a life-threatening gastrointestinal condition predominantly affecting preterm infants. Although multiple births are increasingly common, their specific contribution to NEC risk remains unclear.
OBJECTIVE: To assess the incidence and mortality of NEC in preterm multiple-birth infants in Switzerland over two decades (2000-2021), and to determine whether multiplicity contributes to NEC risk.
METHODS: We conducted a retrospective cohort study of 15,635 infants born before 32 weeks' gestation, using prospectively collected data from the Swiss Neonatal Network.
RESULTS: Of the cohort, 32.8% (n = 5133) were multiple births. The overall NEC incidence was 2.84%, with no statistically significant difference between singletons (2.9%) and multiples (2.7%). NEC-related mortality was high (35.8%) and similar across groups (35.3% in multiple births vs. 36% in singletons). However, within twin pairs, if one twin developed NEC, the second twin's odds increased sixfold (OR 6.1, 95% CI 2.4-16.2). NEC incidence remained stable over the study period.
CONCLUSION: Over a 22-year period, incidence and mortality of NEC in preterm multiple-birth infants in Switzerland remained stable and did not differ significantly from those in singletons. Multiple gestation was not a risk factor for NEC. However, within twin pairs, the diagnosis of NEC in one twin was associated with a sixfold increased odds (OR 6.1, 95% CI: 2.4-16.2) of NEC in the co-twin, raising the estimated risk from 2.7% to 15%. This clustering suggests shared environmental or biological triggers. These findings underscore the importance of vigilant surveillance in the co-twin of an affected infant.
OBJECTIVE: To assess the incidence and mortality of NEC in preterm multiple-birth infants in Switzerland over two decades (2000-2021), and to determine whether multiplicity contributes to NEC risk.
METHODS: We conducted a retrospective cohort study of 15,635 infants born before 32 weeks' gestation, using prospectively collected data from the Swiss Neonatal Network.
RESULTS: Of the cohort, 32.8% (n = 5133) were multiple births. The overall NEC incidence was 2.84%, with no statistically significant difference between singletons (2.9%) and multiples (2.7%). NEC-related mortality was high (35.8%) and similar across groups (35.3% in multiple births vs. 36% in singletons). However, within twin pairs, if one twin developed NEC, the second twin's odds increased sixfold (OR 6.1, 95% CI 2.4-16.2). NEC incidence remained stable over the study period.
CONCLUSION: Over a 22-year period, incidence and mortality of NEC in preterm multiple-birth infants in Switzerland remained stable and did not differ significantly from those in singletons. Multiple gestation was not a risk factor for NEC. However, within twin pairs, the diagnosis of NEC in one twin was associated with a sixfold increased odds (OR 6.1, 95% CI: 2.4-16.2) of NEC in the co-twin, raising the estimated risk from 2.7% to 15%. This clustering suggests shared environmental or biological triggers. These findings underscore the importance of vigilant surveillance in the co-twin of an affected infant.