Contemporary Outcomes for Infants with Necrotizing Enterocolitis—A Systematic Review

Jones, I H; Hall, Nigel

doi:10.1016/j.jpeds.2019.11.011

Cited by 195 publications

(143 citation statements)

References 52 publications

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“…Necrotising enterocolitis continues to be one of the most devastating diseases affecting preterm infants in particular, with persistent high mortality and morbidity 6 . Injury in NEC usually begins with a breach of the intestinal mucosal barrier leading to bacterial translocation across the epithelium and exacerbation of the inflammatory cascade, resulting in the clinical signs of NEC.…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review article presented contemporary outcome numbers for infants with NEC. The overall mortality was 23.5% in all neonates with confirmed NEC (Bell stage 2aplus), 34.5% for neonates that underwent surgery for NEC, 40.5% for extremely low birth weight infants (<1000 g) and 50.9% for extremely low birth weight infants with surgical NEC 6 . Necrotising enterocolitis is not only a disease of preterm infants: in a retrospective chart analysis of 170 infants, NEC was found in 28 (17%) term infants 7 .…”

Section: Introductionmentioning

confidence: 99%

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Introducing multi‐modal enteral medication reduced morbidity and mortality associated with necrotising enterocolitis

et al. 2020

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Aim Necrotising enterocolitis (NEC) is still a disease with high morbidity and mortality. The aim of the study was to analyse retrospectively whether the introduction of a multi‐modal three‐component enteral medication regimen resulted in a change in morbidity and mortality in neonates with NEC. Methods When diagnosis of NEC was established, the following multi‐modal three‐component enteral medication regimen was administered enterally (via nasogastric tube): an antibiotic, an antifungal agent and a probiotic. The primary outcome parameters were intestinal perforation, surgical interventions and mortality during the observational periods. Results In the study period, 2212 patients were admitted to the NICU, out of which 200 (9%) developed NEC. Significantly fewer infants died in the Intervention Group (13 of 104 infants, 13%) compared to the Control Group (38 of 96 infants, 40%) (P = .0001). No infant in the Intervention Group (0%) presented with an intestinal perforation, as compared to 15 infants (16%) within the Control Group (P = .0001). In the Control Group, 21 infants (22%) needed surgical intervention, whereas 0 (0%) infants needed this in the Intervention Group. Conclusion The introduction of an enteral multi‐modal three‐component medication regimen resulted in a significant reduction of mortality and of need for surgical intervention in infants suffering from NEC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Introducing multi‐modal enteral medication reduced morbidity and mortality associated with necrotising enterocolitis

et al. 2020

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“…Necrotizing enterocolitis (NEC) is one of the most common and critical gastrointestinal emergencies in neonates, which predominately affects premature and low birth weight infants in the first weeks of life. Surgical NEC is known to be associated with a significantly higher morbidity and mortality [1,2]. However, the optimal timing for surgical intervention in neonates with NEC is not yet established [3,4].…”

Section: Introductionmentioning

confidence: 99%

C-reactive protein/albumin ratio is a prognostic indicator for predicting surgical intervention and mortality in neonates with necrotizing enterocolitis

et al. 2021

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Purpose The role of hypoalbuminemia and raised C-reactive protein (CRP) levels in predicting critical prognosis has been described extensively in adult literature. However, there are limited studies in pediatrics, particularly neonates. The CRP/albumin (CRP/ALB) ratio is often associated with higher mortality, organ failure and prolonged hospital stay. We hypothesized that the serum CRP/ALB ratio has a prognostic value in predicting surgery and mortality in neonates with necrotizing enterocolitis (NEC). Methods Retrospective review of all neonates with clinical and radiological evidence of non-perforated NEC that were treated in a tertiary-level referral hospital between 2009 and 2018. General patient demographics, laboratory parameters and outcomes were recorded. Receiver operating characteristics analysis was performed to evaluated optimal cut-offs and area under the curve (AUC) with 95% confidence intervals (CI). Results A total of 191 neonates were identified. Of these, 103 (53.9%) were born at ≤ 28 weeks of gestation and 101 (52.9%) had a birth weight of ≤ 1000 g. Eighty-four (44.0%) patients underwent surgical intervention for NEC. The overall survival rate was 161/191 (84.3%). A CRP/ALB ratio of ≥ 3 on day 2 of NEC diagnosis was associated with a statistically significant higher likelihood for surgery [AUC 0.71 (95% CI 0.63–0.79); p < 0.0001] and mortality [AUC 0.66 (95% CI 0.54–0.77); p = 0.0150], respectively. Conclusions A CRP/ALB ratio of ≥ 3 on day 2 is indicative of a critical pathway in neonates with radiologically confirmed, non-perforated NEC. This could be used as an additional criterion to guide parental counselling in NEC for surgical intervention and mortality.

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“…Necrotising enterocolitis (NEC) is a potentially devastating gastrointestinal emergency predominantly affecting preterm infants, with signi cant health burden [1][2][3]. Survivors of surgical NEC are at a high risk for complications such as short bowel syndrome, failure to thrive and neurodevelopmental impairment [4][5][6][7]. The pathogenesis of NEC is poorly understood [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Association of Gastric Residual Volumes With Necrotising Enterocolitis in Extremely Preterm Infants

Purohit¹,

Mehkarkar²,

Athalye-Jape³

et al. 2021

Preprint

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Necrotising enterocolitis (NEC) is a potentially serious illness with significant mortality and morbidity in preterm infants. Previous studies have reported association of volume and colour (bile and blood stained) of gastric residuals (GR) with NEC. We aimed to study this association in our cohort of extremely preterm (EP) infants. In a case-control study using retrospective data (January 2006-December 2011), EP (Gestation <28 weeks) infants with confirmed NEC ≥ Stage II (Cases) were compared with infants without NEC (Controls) matched for birth weight (BW) and gestational age (GA). Forty cases of NEC ≥ Stage II diagnosed at a median (IQR) age of 16.5 (10.3-23) days were compared with 40 controls matched for gestation (±3 days), and birth weight (±680 g). Median maximum GR volume (GRV) from birth to the day of occurrence of NEC was significantly higher in cases vs. controls (5.9 vs.3.7 ml; p<0.001). Increased maximum GRV was associated with NEC ≥ Stage II in adjusted analysis (aOR 1.36, 95%CI 1.06-1.75, p=0.017). There was no significant difference in GRV between cases and controls throughout the clinical course, including 72, 48 and 24 hours before the onset of NEC. However, green (65.0% vs. 27.5%, p=0.001) and haemorrhagic GRs (45.0% vs. 27.5%, p=0.092) were higher 24 hours before the diagnosis of NEC.Conclusion: GRV was not associated with NEC ≥ Stage II. However, green and haemorrhagic GRs were significantly higher 24 hours before the diagnosis of the illness. Adequately powered prospective studies are needed to confirm the significance of our findings.

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Contemporary Outcomes for Infants with Necrotizing Enterocolitis—A Systematic Review

Cited by 195 publications

References 52 publications

Introducing multi‐modal enteral medication reduced morbidity and mortality associated with necrotising enterocolitis

Introducing multi‐modal enteral medication reduced morbidity and mortality associated with necrotising enterocolitis

C-reactive protein/albumin ratio is a prognostic indicator for predicting surgical intervention and mortality in neonates with necrotizing enterocolitis

Association of Gastric Residual Volumes With Necrotising Enterocolitis in Extremely Preterm Infants

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