Clinical impact of NEC-associated sepsis on outcomes in preterm infants

Garg, Parvesh Mohan; Paschal, Jaslyn L.; Ansari, Md Abu Yusuf; Block, Danielle K.; Inagaki, Kengo; Weitkamp, Jörn-Hendrik

doi:10.1038/s41390-022-02034-7

Cited by 20 publications

(18 citation statements)

References 32 publications

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“…In multivariate analyses, risk factors that remained in the model included low birth weight, mechanical ventilation, and late-onset sepsis. As described in the literature, sepsis, low gestational age, and birth weight are well-established risk factors for NEC [4,16,22]. In this study, lower birth weight and sepsis were also independent risk factors following adjustment in the multivariate model.…”

Section: Discussionsupporting

confidence: 65%

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Necrotizing Enterocolitis: Incidence, Risk Factors, and Associated Morbidities in a Large Cohort of Infants with Very Low Birth Weight

2023

J Perina Clin Pediatr

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Objective: Necrotizing Enterocolitis (NEC) causes morbidity and mortality in infancy. This study investigated the incidence, risk factors, morbidity, and mortality rates in a cohort of infants with very low birth weight in Brazil. Study Design: Data were collected from 17 Neonatal Intensive Care Units (NICUs) for infants with very low birth weight of gestational ages 24-36 weeks and delivered during 2015-2019. Data were analyzed using a multivariate logistic regression analysis. Results: Of 7793 newborns, 561 (7.2%) met the criteria for NEC, of whom 295 (52%) underwent clinical treatment and 266 (48%) underwent surgical intervention. NEC incidence varied across neonatal units (from 4.5% to 12.9%) and was stable during the study period for the whole population. However, the incidence over the study period increased from 9.7% in 2015 to 13.9% in 2019 for infants weighing<1000 g. Patients with NEC had lower birth weight, gestational age, and Apgar scores and significantly higher mortality rates than those without (p<0.001). Late-onset sepsis, birth weight, and mechanical ventilation were independent risk factors for NEC. Conclusion: NEC is strongly associated with NICU mortality and largely varies between infants in the NICU. Moreover, the incidence of NEC among extremely low birth infants is constantly increasing.

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Section: Discussionsupporting

confidence: 65%

“…Reperfusion is involved in the induction of an inflammatory cascade, vascular endothelial injury, and increased susceptibility to bacterial translocation. In our study population, patients with late-onset sepsis had a 4-fold higher risk of developing NEC [22].…”

Section: Discussionmentioning

confidence: 80%

Necrotizing Enterocolitis: Incidence, Risk Factors, and Associated Morbidities in a Large Cohort of Infants with Very Low Birth Weight

2023

J Perina Clin Pediatr

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“…In our cohort study [18], we also noted that blood culture-positive sepsis [42.4% vs.23%; p=0.007] was significantly more common among infants with severe AKI. A recently published study [42] of 209 infants with 7 This article is protected by copyright. All rights reserved.…”

Section: Sepsis and Nec-associated Akimentioning

confidence: 99%

Necrotizing Enterocolitis-Associated Acute Kidney Injury—Transforming the Paradigm

Garg,

Shenberger,

South

et al. 2024

Am J Perinatol

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Necrotizing enterocolitis (NEC) is one of the most common conditions requiring emergency surgery in the neonatal intensive care unit and is associated with a septic shock-like state contributing to multi-organ dysfunction. NEC affects 6-10% of very-low birth-weight infants and remains a leading cause of death. The occurrence of severe AKI following surgical NEC is a harbinger of multiple morbidities. This review presents current evidence about the clinical impact of NEC associated AKI on the clinical outcomes. Studies evaluating nephro-protective strategies to prevent AKI and its consequences are greatly needed to improve the post-operative recovery and clinical outcomes in neonates with NEC. Future observational studies and clinical trials in preterm-born infants with NEC prioritize measuring short-term (AKI) and longer term (chronic kidney disease) kidney outcomes. Impact: 1. Severe AKI (stage 2 and 3) occurs in 32.6% of neonates after NEC diagnosis and in 58.7% following surgical NEC diagnosis. 2. NEC associated AKI is associated with severe postoperative course, moderate to severe bronchopulmonary dysplasia, surgical complications, brain injury and longer hospital stay in preterm infants. 3. Severity of NEC associated AKI can be utilized by bedside providers for the prognostication of clinical outcomes in preterm infants.

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“…Neonatal sepsis is characterized by the presence of bacteria, fungi, or viruses in the bloodstream, with preterm infants being most vulnerable, leading to a high rate of mortality and severe morbidity, including poor neurodevelopmental outcome 21 , 22 . Frequent symptoms include high or low body temperature, pneumonia, apnea, lethargy, poor feeding, and bleeding manifestations.…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, neonates with advanced or surgical NEC (Bell’s Stage III) are twice as likely to have culture-proven bacteremia as those with suspected or medical NEC 21 , 26 , 27 . In the setting of intestinal mucosal injury, bacterial translocation into the bloodstream commonly occurs, triggering NEC-associated sepsis, which has recently been reported to be associated with greater inflammatory response and hemodynamic support in preterm as compared with term infants 21 . Intravenous antibiotics that are effective against enteric microbes are a mainstay in treating NEC, even at early stages 28 .…”

Section: Introductionmentioning

confidence: 99%

Necrotizing enterocolitis, gut microbes, and sepsis

et al. 2023

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Necrotizing enterocolitis (NEC) is a devastating disease in premature infants and the leading cause of death and disability from gastrointestinal disease in this vulnerable population. Although the pathophysiology of NEC remains incompletely understood, current thinking indicates that the disease develops in response to dietary and bacterial factors in the setting of a vulnerable host. As NEC progresses, intestinal perforation can result in serious infection with the development of overwhelming sepsis. In seeking to understand the mechanisms by which bacterial signaling on the intestinal epithelium can lead to NEC, we have shown that the gram-negative bacterial receptor toll-like receptor 4 is a critical regulator of NEC development, a finding that has been confirmed by many other groups. This review article provides recent findings on the interaction of microbial signaling, the immature immune system, intestinal ischemia, and systemic inflammation in the pathogenesis of NEC and the development of sepsis. We will also review promising therapeutic approaches that show efficacy in pre-clinical studies.

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Clinical impact of NEC-associated sepsis on outcomes in preterm infants

Cited by 20 publications

References 32 publications

Necrotizing Enterocolitis: Incidence, Risk Factors, and Associated Morbidities in a Large Cohort of Infants with Very Low Birth Weight

Necrotizing Enterocolitis: Incidence, Risk Factors, and Associated Morbidities in a Large Cohort of Infants with Very Low Birth Weight

Necrotizing Enterocolitis-Associated Acute Kidney Injury—Transforming the Paradigm

Necrotizing enterocolitis, gut microbes, and sepsis

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