Objective: To identify statistical associations with necrotizing enterocolitis (NEC) severity as dichotomized into cases with Bell stage II and III disease.
Study Design: We conducted a retrospective study using eight consecutive years of data from a multihospital healthcare system analyzed NEC severity (Bell stage II vs. III).
Results: We identified 220 neonates with stage ≥ II who had 225 separate episodes of NEC (157 stage II and 68 stage III). Those with stage III were born at earlier gestational age (P<0.0001) and lower birth weight (P<0.0001). Diagnosis of NEC occurred on about the same day of life in stage II and stage III cases. Those who developed stage III had significantly higher C-reactive protein (P<0.0001), I/T ratio (P= 0.0005), mean platelet volume (MPV) (P= 0.0001) and lower pH (P<0.0001) and platelet counts (P<0.0001). Transfusions were more common to those who progressed to stage III (P<0.0001). Regression analysis indicated higher odds of stage III in relationship to the volume of RBC transfusions (OR 2.41, {CI 1.85 to 3.11}, P<0.0001) and pasteurized human milk (PHM) (OR 1.32, {CI 1.07 to 1.62}, P = 0.0089). In contrast, feeding early mother's own milk (colostrum) for five days reduced the odds for stage III (OR 0.802, {CI 0.67 to 0.96}, P=0.0170). Those with small bowel resection were less likely to have received mother's own milk before NEC (OR 0.94, {CI 0.89 to 0.99}, P = 0.019) and factors predicting death from NEC were a low pH (OR 2.21, {CI 1.27 to 3.85}, P = 0.0005) and less colostrum (OR 0.96, {CI 0.94 to 0.99}, P = 0.003).
Conclusions: RBC transfusions and PHM increased the odds for stage III NEC, whereas early mother's own milk five days reduced the odds. Mother's own milk with PHM decreased the risk for small bowl resection and early mother's milk decreased the odds for mortality from NEC. Future research and prospective randomized controlled studies are needed to quantify any reduction in NEC severity on the basis of decreasing RBC transfusions and increasing early mother's own milk or colostrum.



College and Department

Life Sciences; Nutrition, Dietetics, and Food Science



Date Submitted


Document Type





NEC, surgery, transfusion, feeding, colostrum