Publication:

Necrotizing enterocolitis in an extremely preterm infant born to a mother with type 1 diabetes mellitus: a case report with focused literature review

Necrotizing enterocolitis is a major cause of morbidity and mortality in very preterm infants. Maternal type 1 diabetes mellitus is strongly associated with prematurity, but its independent association with necrotizing enterocolitis remains uncertain. A 27-year-old woman with pregestational type 1 diabetes mellitus developed threatened preterm labour and later delivered a male infant at 27 weeks and 4 days of gestation weighing 880 g. The infant required intubation and surfactant therapy for extreme prematurity. During the neonatal course, he developed abdominal distension, bilious aspirates, worsening respiratory status, and mixed acidosis consistent with Bell stage IIA necrotizing enterocolitis. Management included bowel rest, gastric decompression, intravenous antibiotics, parenteral nutrition, close monitoring, and early surgical review. Feeds were later reintroduced using expressed breast milk, and the infant recovered without surgery, was discharged home, and remained well at follow-up, with appropriate growth and no recurrent gastrointestinal symptoms. Relevant cohort studies, meta-analyses, and guideline-level evidence regarding maternal type 1 diabetes mellitus, prematurity, and necrotizing enterocolitis were reviewed. Current evidence supports a strong association between maternal type 1 diabetes mellitus and prematurity, while evidence for an independent association with necrotizing enterocolitis remains inconsistent. This case emphasizes the importance of antenatal optimization, early neonatal stabilization, prompt recognition of intestinal disease, careful reintroduction of human milk feeding, and structured post-discharge follow-up.