Contributing Factors for Development of Necrotizing Enterocolitis in Preterm Infants in the Neonatal Intensive Care Unit

Abstract

Background: necrotizing enterocolitis is a serious condition that affects mostly preterm infants, with high mortality rate. Aim: to estimate the influence of potentially contributing factors of this multifactorial disease. Methods: the study group included 51 necrotizing enterocolitis infants who were less than 37 week gestation who were hospitalized in NICU during a five year period. The control group consisted of 71 patients with approximately the same gestational age and birth weight. Average gestational age in the study group was 30.2 weeks (SD 3.7), average birth weight 1502g (SD 781.5). Average postnatal age in the time of the presenting NEC was 18.2 days (SD 12.8). Results: Logistic regression estimates the influence of risk factors, which in our study related to the treatment of preterm infants on the likelihood of NEC development. Our regression model consisted of seven independent variables (nosocomial infections, mechanical ventilation, nasal continuous positive pressure, morphine, inotropes, blood transfusions, and H2 blockers), which were shown to have a statistically significant impact, X2 (7, n=1222) = 49.522, p<0.0001; two independent variables (nosocomial infection and H2 blockers use) were statistically significant. Preterm infants with nosocomial infection had a three times greater chance of developing NEC, and infants who received H2 blockers had a 1.5 higher risk. Conclusions: Underlying pathology of very low birth weight infants and their treatment in NICU contribute to NEC development. Identifying risk factors can be crucial for the early diagnosis and outcome of disease. Awareness of risk factors should influence changes in practice to reduce the risk of NEC.

Erythromycin and Reflux Events in Premature Neonates

“…to 19 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) and by 10 events in the placebo group to 19 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) per 24 hours (P ¼ 0.09). In addition, there was also no significant difference in acidic reflux (P ¼ 0.14), nonacidic reflux (P ¼ 0.46), proximal reflux (P ¼ 0.54), total reflux time (P ¼ 0.502), percent reflux time (P ¼ 0.86), bolus clearance time (P ¼ 0.49), or longest bolus clearance time (P ¼ 0.92) in the pre and post pH-MII studies of both treatment groups (Figs.…”

“…One study reported that about 25% of extremely low birth weight infants were discharged home on medications for GERD (30). Given recent evidence that antacid medications increase the risk for bloodstream infections and necrotizing enterocolitis, pro‐motility agents are being used as the “safer” alternative to medically treat reflux (31,32). Our study, however, does not support their use to decrease reflux events.…”

Healthcare-associated Infections in Very Low Birth–weight Infants in a South African Neonatal Unit: Disease Burden, Associated Factors and Short-term Outcomes

“…45 The higher incidence of cPVL, NEC, patent ductus arteriosus and bronchopulmonary dysplasia among infants with any HAI episode is not surprising and in keeping with the increased HAI associated risk described by several authors, especially in neonates with multiple episodes of infection. 46,47 The all-cause mortality in the VLBW admission cohort over the 2-year period was 16.0% (unpublished data). This is higher than the mortality reported from high-income settings, for example, Germany (9.9%) 48 and Israel (13.8%), 49 and markedly lower than that reported from other African neonatal units [Johannesburg (26.6%), 50 Limpopo (22.6%) 51 and Malawi (58%) 52 ].…”

“…The higher incidence of cPVL, NEC, patent ductus arteriosus and bronchopulmonary dysplasia among infants with any HAI episode is not surprising and in keeping with the increased HAI associated risk described by several authors, especially in neonates with multiple episodes of infection. 46 , 47 …”

The contribution of morphine sulfate to the development of necrotizing enterocolitis in preterm infants: a matched casecontrol study

“…It is well recognized that the etiology of necrotizing enterocolitis (NEC) is multifactorial [1][2][3] but exact pathophysiological mechanisms remain unclear. 4 Many low birth weight preterm newborns and sick full-term newborns, including those with NEC, require respiratory support using endotracheal intubation and mechanical ventilation.…”