Incidence, Risk Factors, and Mortality of Necrotizing Enterocolitis Among Neonates Admitted to Mubende and Fort Portal Regional Referral Hospitals, Uganda

Background Necrotizing enterocolitis (NEC) is a life-threatening gastrointestinal condition affecting neonates, characterized by abdominal distension, feeding intolerance, and bloody stools, with or without radiological signs such as pneumatosis intestinalis, portal venous gas, or pneumoperitoneum. Despite its significant contribution to neonatal morbidity and mortality, most epidemiological data originate from high-income countries, leaving a gap in evidence from low-resource settings. Objective To determine the incidence, associated risk factors, and mortality of NEC among neonates aged ≤ 28 days in two regional referral hospitals in Uganda. Methods A prospective cohort study was conducted at Mubende and Fort Portal Regional Referral Hospitals. Neonates with major gastrointestinal malformations or referred to other facilities were excluded. NEC diagnosis was based on modified Bell’s criteria. A total of 424 neonates were enrolled, comprising 38.9% term and 61.1% preterm infants. Results Thirty neonates developed NEC, yielding an incidence proportion of 7.1%, significantly higher among preterm neonates (p < .001). Multivariable logistic regression identified the following independent risk factors (p < .05 for all): maternal chronic illness (particularly HIV), history of preeclampsia, presentation after 14 days of life, very preterm birth, extremely low birth weight, very low birth weight, and neonatal sepsis. Mortality was markedly elevated in neonates with NEC compared to those without (26.8% vs. 2.3%, p < .001). Conclusion NEC incidence in this low-resource setting is notably high, especially among preterm neonates. These findings underscore the urgent need for targeted interventions to reduce neonatal sepsis, prevent preterm births, address intrauterine growth restriction, and strengthen maternal HIV control measures to improve neonatal outcomes.