Clinical impact of early-onset sepsis on outcomes of necrotizing enterocolitis: a retrospective case-control study

PURPOSE: Early-onset sepsis (EOS) is a significant issue associated with high morbidity and mortality in newborns, yet it has not received adequate attention among neonatal necrotizing enterocolitis (NEC). This study aimed to investigate the clinical characteristics of NEC patients with EOS and to assess the association between EOS and NEC-related outcomes. PATIENTS AND METHODS: The retrospective case-control study included 196 NEC patients (Bell's stage ≥ II) admitted to a tertiary neonatal intensive care unit from January 2023 to March 2025. Of these, 98 patients with EOS were matched to 98 controls (without EOS) based on birth weight, gestational age, and gender. The medical records of eligible patients were reviewed, and the clinical characteristics were systematically analyzed. Statistical analyses were performed using R software. RESULTS: The cohort included 196 patients, with a median gestational age of 32.1 weeks (IQR: 29.5, 34.4) and a median birth weight of 1615.0 g (IQR: 1227.5, 2050.0). Compared with the controls, cases showed significantly higher inflammatory markers (CRP and procalcitonin), lower platelet count, and higher incidences of hypoproteinemia, shock, and coagulopathy (all P < 0.05). Furthermore, ventilator support, blood transfusion, using of inotropes (dopamine), and Bell stage III were significantly more frequent among cases. Both the rate of surgical intervention [67.35% vs. 22.45%] and mortality [29.59% vs. 8.16%] were markedly elevated in the cases than in the controls. In multivariate conditional Logistic regression analysis, EOS emerged as an independent risk factor for both NEC-related surgical intervention [odds ratio (95% confidence interval) = 3.853 (1.724-8.612)] and death [odds ratio (95% confidence interval) = 5.017 (2.083-12.087)]. CONCLUSION: The clinical characteristics of medical conditions identified in patients with EOS were distinct from those observed in patients without EOS. Moreover, EOS was associated with increased odds of NEC-related surgical intervention and mortality.