500 Epidemiologic Characteristics of Necrotizing Enterocolitis (Nec) in Georgia

Abstract

L i t t l e epidemiologic a t t e n t i o n has been given t o i n f a n t s 82500 gms. admitted t o NICU's. To determine t h e i r morbidity and mort a l i t y , we reviewed a l l admissions f o r 17 months and they represented 44% (236/545) of t h e admissions and 37% of a l l deaths. The diagnoses were: Pulmonary disease (PD) o t h e r than meconium a s p i r a t i o n syndrome (MAS) (32%) ; asphyxia ( A s ) ( 2 2 % ) ; congenit a l anomalies & h e a r t disease (CA/CHD) (21%) ; s u r g i c a l (11%) ; s e p s i s (5%) ; o t h e r s ( 9 % ) . MAS occurred i n 44% (22/50) of A s inf a n t s . Mortality r a t e was 17% (40/236). Of t h e deaths, 70% were due t o CA/CHD, 23% t o A s and 7% t o s e p s i s . Of t h e 9 A s deaths, a l l were742 wks.and 8 had MAS. Of 21 cases with pers i s t e n t f e t a l c i r c u l a t i o n (PFC), 17 had As, 16 were >42 wks and 7 (33%) died. I n i n f a n t s with PFC, A s and MAS who were >42 wks, m o r t a l i t y was 55%. Thirty four i n f a n t s (14%) were >42 wks, 9 (27%) died. S i x t y seven (28%) were637 wks, only 3 died (4%) & they had CA/CND. PD o t h e r than MAS occurred i n 54/67 (80%). None of t h e 5 3 7 wks.who had PD and were born by e l e c t i v e c-section o r induction had p r e n a t a l lung maturity s t u d i e s .Morbidity and m o r t a l i t y remains high i n t h i s group of i n f a n t s . Prevention of postmaturity and b e t t e r intrapartum management should s i g n i f i c a n t l y decrease t h e number of deaths. Accurate assessment of lung maturity and g e s t a t i o n a l age, i n order t o avoid i a t r o g e n i c prematurity, w i l l decrease t h e number of infants&2500 9ms requiring neonatal i n t e n s i v e c a r e . T h i r t y white and 30 black c h i l d r e n , ages 2 months t o 7 y e a r s , form t h e study group. I n each group, t h e age, number of other s i b l i n g s , duration of fever a f t e r s t a r t i n g therapy, i n i t i a l white c e l l count, and morphological and chemical findings of t h e cerebrospinal f l u i d were recorded. Immunoglobulins were measured i n each group by r a d i a l immunodiffusion. Anticapsular antibody was measured by radioimmunoassay i n both groups. HLA antigens were determined i n all p a t i e n t s from lymphocytes i s o l a t e d from t h e p e r i p h e r a l blood by f i c o l l isopaque centrifugation.The black children responded t o t h e i n f e c t i o n l e s s vigorously. They had more prolonged fever ( P <.01), a lower CSF pleocytosis ( p c.05). and l e s s IgG production ( p <.05). They produced l e s s anticapsular antibody -234.4 ngmlml geometric mean t i t r e v s .312.3 ngmlml f o r t h e white children. The black children had increased frequency of HLA B7 ( p <.001), and t h e white children an increased frequency of B12 ( p <.05). These HLA antigenic d i fferences could not be accounted f o r by r a c i a l t r a i t s . Immune response regulated by Ir genes i n c l o s e proximity of t h e B locus i s t h u s weaker i n black children and may explain t h e incr...

Serum Acute Phase Reactants in Necrotizing Enterocolitis

“…Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in the newborn, affecting 1 to 5% of infants admitted to intensive care nurseries (1). The most severe cases usually have radiographic signs of intramural gas (pneumatosis intestinalis) and/or perforation, but the diagnosis is more difficult in infants lacking these classical features who often have a non-specific radiographic pattern of ileus.…”