Necrotizing enterocolitis in very preterm infants: an epidemiological study in Jiangsu, China.

Background: Epidemiological data focusing on clinical practices for necrotizing enterocolitis (NEC) in China remains scarce. To characterize the incidence, clinical management, and outcomes of NEC among very preterm infants (VPIs) in China. Methods: This study included all VPIs (gestational age <32 weeks) admitted to seven hospitals in Jiangsu, China between 2019 and 2021. Infants who died or were discharged within 72 h were excluded. NEC was defined as Bell's stage ≥ II. Results: Among 3,088 included infants, NEC incidence was 5.1% (156/3,088), decreasing with advancing gestational age: 7.7% at <28 weeks, 5.8% at 28-29 weeks, and 3.7% at 30-31 weeks. The rates of key perinatal/neonatal practices were 78.1% for antenatal steroids, 17.7% for delayed cord clamping, and 52.1% for human milk feeding. Among 156 NEC cases, NEC mortality was 16.7% (26/156), peaking at 30% in <28w group. Median nil per os duration was 8 (IQR: 5-11) days and time to full feeds was 25 (IQR: 14-38) days post-onset. Only 18.0% were initiated any human milk feeding after the NEC-related fasting period. Median antibiotic duration for NEC was 17 (IQR: 11-26) days, and 51.9% of cases received carbapenems. Conclusions: Overall NEC incidence and mortality in VPIs were comparable to high-income country benchmarks; however, the 28-31 week subgroup showed higher incidence than these benchmarks, whereas the <28 week subgroup showed higher mortality. These findings highlight the importance of gestational-age-stratified interpretation and may inform future quality improvement efforts in perinatal care, human milk feeding, and antibiotic stewardship.