Delay in achieving enteral autonomy and growth outcomes in very low birth weight infants with surgical necrotizing enterocolitis

Goddard, Gillian R.; Jenkins, Todd M.; Poindexter, Anne; Wessel, Jacqueline; Helmrath, Michael A.; Poindexter, Brenda B.

doi:10.1038/s41372-020-00880-z

Cited by 6 publications

(8 citation statements)

References 27 publications

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“…These findings indicate a higher degree of lung compromise by NEC with a more severe inflammatory process and associated multisystem morbidity. We also noticed infants with moderate to severe BPD had poor linear growth at 36 weeks following NEC, as shown in a few reports [26][27][28].…”

Section: Discussionsupporting

confidence: 78%

“…We also noticed infants with moderate to severe BPD had poor linear growth at 36 weeks following NEC, as shown in a few reports. [26][27][28] In this cohort, preterm infants with moderate to severe BPD had more severe AKI (67.6 vs. 28.6%) following NEC. AKI appears not to be an isolated event but instead reflects remote multiorgan dysfunction involving the lungs, heart, liver, intestines, and brain through an inflammatory mechanism involving neutrophil migration and cytokine expression increased oxidative stress as shown in animal models.…”

Section: Discussionmentioning

confidence: 72%

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Clinical Correlates of Moderate-to-Severe Bronchopulmonary Dysplasia in Preterm Infants following Surgical Necrotizing Enterocolitis

et al. 2022

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Objective: To determine clinical correlates of moderate to severe bronchopulmonary dysplasia (BPD) in preterm infants following surgical necrotizing enterocolitis (NEC). Methods: A retrospective, single-center cohort study comparing patients with moderate to severe BPD to patients with non/mild BPD among surgical NEC infants. BPD was defined by NIH 2001 consensus definition Results: Of 92 consecutive neonates with surgical NEC, 77% (71/92) had moderate/severe BPD and 22% (21/92) had non/mild BPD. The patent ductus arteriosus (PDA) was significantly higher in those developing moderate/severe BPD (67.6% [48/71]) than non/mild BPD (28.6% [6/21]; p=0.001). Postoperatively,infants with moderate/severe BPD had more severe AKI (67.6% [48/71] vs. 28.6% [6/21]; p=0.001), were intubated longer (40.5 days [IQR 12, 59] vs. 6 days [IQR 2, 13]; p<0.001), received more parenteral nutrition (109 days [IQR 77, 147] vs. 55 days [IQR 19, 70]; p<0.001), developed higher surgical morbidity (46.5% [33/71] vs. 14.3% [3/21]; p=0.008), had more intestinal failure (62.5% vs. 13.3%; p<0.001), required a longer hospital stay (161 days [IQR 112, 186] vs. 64 days [IQR 20, 91]; p<0.001), and were more likely to need home oxygen. In a multivariable analysis, lower birth weight (OR=0.3, [95% CI 0.1-0.5]; p=0.001), patent ductus arteriosus (OR=10.3, [95%CI 1.6-65.4]; p=0.014) and longer parenteral nutritional days (OR=8.8; [95%CI 2.0 -43.0]; p=0.005) were significantly and independently associated with higher odds of moderate/severe vs. non/mild BPD. Conclusion: Development of moderate/severe BPD occurred in the majority of preterm infants with surgical NEC in this consecutive series. Preterm infants with moderate/severe BPD were more likely to have a PDA before NEC. Development of moderate/severe BPD was associated with significantly greater burden and duration of post-operative morbidity following surgical NEC. Identifying surgical NEC infants at increased risk of moderate/severe BPD and developing lung protection strategies may improve surgical NEC outcomes.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 72%

Clinical Correlates of Moderate-to-Severe Bronchopulmonary Dysplasia in Preterm Infants following Surgical Necrotizing Enterocolitis

et al. 2022

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“…[8] Although the symptoms of NEC can be relieved through conservative treatments such as fasting, parenteral nutrition, fluid resuscitation, antibiotics, and maintaining acid-base balance, there are still a considerable number of children with NEC that require surgical treatment. [9,10] There-Editor: Khaled Saad.…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, the rapid development of perinatal science and neonatal intensive care treatment technology have significantly improved the survival of low birth weight or premature infants [8] . Although the symptoms of NEC can be relieved through conservative treatments such as fasting, parenteral nutrition, fluid resuscitation, antibiotics, and maintaining acid-base balance, there are still a considerable number of children with NEC that require surgical treatment [9,10] . Therefore, it is necessary to further explore the clinical features and influencing factors of NEC in low birth weight infants, and provide evidence support for the prevention and treatment of clinical NEC.…”

Section: Introductionmentioning

confidence: 99%

The predictors of necrotizing enterocolitis in newborns with low birth weight

Tan¹,

Zhou²,

Xu³

et al. 2022

Medicine

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There are needs to investigate the influencing factors of necrotizing enterocolitis (NEC) in low birth weight (LBW) newborns, to provide insights into the clinical management of NEC.This study was a retrospective cohort study. Infants admitted to our hospital from January 1, 2019 to June 30, 2021 were selected. The clinical characteristics of NEC and no-NEC infants were evaluated. Logistic regression analyses were conducted to assess the risk factors of NEC in LBW infants.A total of 192 LBW infants were included, the incidence of NEC in LBW infants was 35.42%. There were significant differences in the congenital heart disease, sepsis, breastfeeding, blood transfusion and probiotics feeding between NEC and no-NEC group (all P < .05), and there were no significant differences in birth weight, gestational age, mother's pregnancy-induced hypertension, premature rupture of fetal membrane, amniotic fluid pollution, fetal asphyxia, neonatal respiratory distress syndrome and mechanical ventilation between NEC and no-NEC group (all P > .05). Congenital heart disease (OR: 2.128, 95% CI: 1.103–3.511), sepsis (OR: 1.630, 95% CI: 1.022–2.549), and blood transfusion (OR: 1.451, 95% CI: 1.014–2.085) were the independent risk factors for NEC in LBW infants, and breastfeeding (OR: 0.494, 95% CI: 0.023–0.928), probiotics feeding (OR: 0.816, 95% CI: 0.782–0.982) were the protective factors for the NEC in LBW infants. The prognosis of NEC infants undergone surgery treatment was better than that of infants undergone conservative treatments (P = .043).The incidence of NEC in LBW is high, which is affected by many factors, and comprehensive interventions targeted on the risk and protective factors should be made to improve the prognosis of LBW infants.

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“…In most cases, the intestinal failure will resolve. 8 , 9 In some cases, typically after extensive intestinal surgery, short bowel syndrome (SBS) will develop. This can lead to inadequate absorption of nutrients and affected long-term growth.…”

Section: Introductionmentioning

confidence: 99%

Body composition and bone mass among 5-year-old survivors of necrotizing enterocolitis

Magnusson

Swolin-Eide²,

Elfvin³

2022

Pediatr Res

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Background Necrotizing enterocolitis (NEC) affects the intestine of preterm infants. Preterm infants risk inadequate bone mineralization. This risk may increase if the intestinal uptake of minerals is affected after NEC. Methods This is a study of growth, bone mineral density (BMD), bone mineral content (BMC), and body composition at 5 years of age among Swedish children born before gestational week 37 + 0 with a history of NEC, minimum stage IIA, compared to matched controls. Fifty children, 25 NEC cases and 25 controls, were examined with dual energy X-ray absorptiometry (DXA) and DXA with laser. Results The NEC cases had lower weight, −1.3 SDS vs −0.7 SDS, a lower fat mass and fat percent, 23.4 vs 29.1%, compared to the controls. NEC cases had lower BMC total body head excluded, 355.6 g vs 416.7 g. BMD Z-scores were lower among NEC cases in total body head excluded, −0.7 vs −0.1, and in lumbar spine. Conclusions Preterm NEC survivors at 5 years of age had reduced growth, an altered body composition, and indications of a lower bone mass compared to matched controls. The study suggests that preterm infants diagnosed with NEC need special attention during childhood regarding growth and bone health. Impact A follow-up longitudinal study of growth, bone health, and body composition at 5 years of age among children born preterm with a history of NEC compared to matched controls. The NEC cases had lower weight than controls. NEC cases had an altered body composition with lower fat mass compared to controls. The DXA results showed that the NEC cases had lower bone mineral content and a tendency to lower bone mineral density. The study suggests that preterm infants diagnosed with NEC need special attention at follow-up regarding growth and bone health compared to preterm infants without NEC.

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Delay in achieving enteral autonomy and growth outcomes in very low birth weight infants with surgical necrotizing enterocolitis

Cited by 6 publications

References 27 publications

Clinical Correlates of Moderate-to-Severe Bronchopulmonary Dysplasia in Preterm Infants following Surgical Necrotizing Enterocolitis

Clinical Correlates of Moderate-to-Severe Bronchopulmonary Dysplasia in Preterm Infants following Surgical Necrotizing Enterocolitis

The predictors of necrotizing enterocolitis in newborns with low birth weight

Body composition and bone mass among 5-year-old survivors of necrotizing enterocolitis

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