{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:59:49Z","timestamp":1790315989846,"version":"4.1.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>\n                    Between January 2018 to June 2020, 119 of 1,106 Very Low Birth Weight (VLBW) neonates admitted to Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) were diagnosed with Necrotising Enterocolitis (NEC), representing 10.8% of the VLBW neonates. This retrospective matched case-control study (119 cases, 119 controls; matched 1:1 on birthweight \u00b1100\u2005g, gestational age \u00b12 weeks, and postnatal age \u00b11 week) aimed to determine the prevalence, risk factors, and outcomes of NEC in VLBW neonates at a tertiary hospital in South Africa. We handled missing data using Multiple Imputation by Chained Equations (MICE, M\u2009=\u200920) after confirming the data were Missing at Random. We used MI-pooled conditional logistic regression for all analyses to account for the matched design. The mortality rate among NEC cases was 49.6%. On univariate analysis, outborn status (cOR 3.69, 95% CI 1.84\u20137.43), conventional ventilation (cOR 4.73, 95% CI 2.52\u20138.88), late-onset sepsis (cOR 6.29, 95% CI 3.02\u201313.07), and fungal sepsis (cOR 6.50, 95% CI 2.27\u201318.62) were significantly associated with NEC. In the multivariable analysis, conventional ventilation (acOR 3.37, 95% CI 1.42\u20138.01,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.006) and late-onset sepsis (acOR 5.27, 95% CI 1.84\u201315.06,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002) were independently associated with NEC. The final model demonstrated excellent discrimination (AUC\u2009=\u20090.827). Maternal factors were not independently associated with NEC. The prevalence and mortality of NEC among VLBW neonates remain high in this tertiary setting; this aligns with previous studies from the region. Late-onset sepsis and conventional ventilation were the strongest independent risk factors, highlighting the importance of stringent infection prevention and early recognition of clinical deterioration.\n                  <\/jats:p>","DOI":"10.3389\/fped.2026.1878637","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:32:10Z","timestamp":1790314330000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A case-control study of necrotising enterocolitis in very low birth weight neonates at a tertiary hospital in South Africa"],"prefix":"10.3389","volume":"14","author":[{"given":"Nkatha","family":"Meme","sequence":"first","affiliation":[{"name":"Department of Paediatrics and Child Health, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand","place":["Johannesburg, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajayi","family":"Oluseyi Mojisola","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand","place":["Johannesburg, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanusha","family":"Ramdin","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand","place":["Johannesburg, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"233","DOI":"10.3233\/NPM-16915130","article-title":"Necrotising enterocolitis in premature infants and newborns","volume":"9","author":"Muller","year":"2016","journal-title":"J Neonatal-Perinat Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e0224880","DOI":"10.1371\/journal.pone.0224880","article-title":"Clinical characteristics of neonatal fulminant necrotizing enterocolitis in a tertiary Children's Hospital in the last 10 years","volume":"14","author":"Lin","year":"2019","journal-title":"PLoS One"},{"key":"B3","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1159\/000489677","article-title":"Risk factors for necrotizing enterocolitis: a prospective multicenter case-control study","volume":"114","author":"Berkhout","year":"2018","journal-title":"Neonatology"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1611111","DOI":"10.3389\/fped.2025.1611111","article-title":"Risk factors and outcomes of infants with necrotizing enterocolitis: a case-control study","volume":"13","author":"Kamanga","year":"2025","journal-title":"Front Pediatr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"9","DOI":"10.7196\/SAJCH.2023.v17i1.1939","article-title":"Outcome of infants with necrotising enterocolitis at charlotte maxeke Johannesburg academic hospital, South Africa","volume":"21","author":"Selse","year":"2023","journal-title":"South Afr J Child Health"},{"key":"B6","doi-asserted-by":"publisher","first-page":"fmaa130","DOI":"10.1093\/tropej\/fmaa130","article-title":"Outcomes of neonates requiring neonatal intensive care admission for necrotizing enterocolitis in a resource-restricted hospital in Cape Town, South Africa","volume":"67","author":"Satardien","year":"2021","journal-title":"J Trop Pediatr"},{"key":"B7","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1186\/s12887-020-02231-5","article-title":"Global incidence of necrotizing enterocolitis: a systematic review and meta-analysis","author":"Alsaied","year":"20","journal-title":"BMC Pediatr"},{"key":"B8","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/S12887-015-0337-4","article-title":"Comparison of morbidity and mortality of very low birth weight infants in a central hospital in Johannesburg between 2006\/2007 and 2013","volume":"15","author":"Ballot","year":"2015","journal-title":"BMC Pediatr"},{"key":"B9","doi-asserted-by":"publisher","first-page":"A136","DOI":"10.1136\/archdischild-2024-rcpch.200","article-title":"6289 The incidence and determinants of necrotising enterocolitis among neonates at a public hospital in South Africa (2013\u20132018)","volume":"109","author":"Ajayi","year":"2024","journal-title":"Arch Dis Child"},{"key":"B10","doi-asserted-by":"publisher","first-page":"900","DOI":"10.7196\/SAMJ.2017.v107i10.12463","article-title":"Short-term outcomes of inborn v. 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