ENTERAL THEOPHYLLINE AND NECROTIZING ENTEROCOLITIS IN THE LOW-BIRTH-WEIGHT INFANT

In a two-phased retrospective study, clinical factors associated with the development of necrotizing enterocolitis (NEC) in neonates were id entified. The first phase found 13 infants with NEC who had been treat ed more frequently with enteral theophylline (P<.025) and fed higher v olumes (>150 mL/kg/day; P<.05) than controls of comparable birthweight and postnatal age. Seven of the 13 infants with NEC, weighing <1,250 g at birth, had previously received intravenous aminophylline and been changed to enteral theophylline within six days before the onset of N EC. Prolonged rupture of membranes was more prevalent (P<.025) in infa nts with birthweight >1,250 g who developed NEC in the first week of l ife. Maternal preeclampsia helped protect against the development of N EC (P<.05). In the second study phase, 59 infants with birthweights <1 ,250 g were evaluated for gastrointestinal disturbance within five day s of the introduction of any enteral medication. The frequencies of NE C, NEC scare, and feeding intolerance were greater in infants treated with enteral theophylline than in those treated with all other enteral medications combined (P<.05). This two-phased study confirms the mult ifactorial etiology of NEC and indicates that the administration of en teral theophylline to young infants <1,250 g may be a predisposing fac tor to GI disturbances and NEC. These findings warrant a further prosp ective investigation.