Effect of Deregionalized Care on Mortality in Very Low-Birth-Weight Infants With Necrotizing Enterocolitis

Kastenberg, Zachary J.; Lee, Henry; Profit, Jochen; Gould, Jeffrey B.; Sylvester, Karl G.

doi:10.1001/jamapediatrics.2014.2085

Cited by 73 publications

(55 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We included two studies from Canada: one provided the most recent data from 2008 to 2012 for babies born less than 29 weeks10 and the other included the most recent data from 2003 to 2011 for babies born 29–32 weeks’ GA 11. We included two studies from the USA with overlapping time periods: one from 511 US Vermont Oxford Network Centres in 2005–2006 across birth weight categories ≤1500 g12 and a regional study with more recent data from California in 2005–2011 by GA categories 13. We included one study from each of the following countries: Finland, Germany, Italy, Japan, Korea, Poland, Spain, Sweden and Switzerland.…”

Section: Resultsmentioning

confidence: 99%

Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review

Battersby

Santhalingam

Costeloe

et al. 2018

Arch Dis Child Fetal Neonatal Ed

209

135

View full text Add to dashboard Cite

show abstract

Section: Resultsmentioning

confidence: 99%

Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review

Battersby

Santhalingam

Costeloe

et al. 2018

Arch Dis Child Fetal Neonatal Ed

209

135

View full text Add to dashboard Cite

show abstract

“…Comparisons with other population based studies are hampered by the differences in case-definitions and inclusion criteria 6,10,[28][29][30][31] In the United Kingdom there have been two studies in the last decade, EPICure 2, 30 restricted to neonates born up to 26 weeks GA, and a four month prevalence study with a low response rate. 23 Wide global variation is reported in the rate of NEC of all grades of severity, but our rates for laparotomy and mortality are similar to published data from Canada, 32,33 Australia 6 , and the United States.…”

mentioning

confidence: 99%

Incidence and enteral feed antecedents of severe neonatal necrotising enterocolitis across neonatal networks in England, 2012–13: a whole-population surveillance study

Battersby

Longford

Mandalia

et al. 2017

The Lancet Gastroenterology & Hepatology

110

View full text Add to dashboard Cite

Word count: Abstract (300 /300w) Background: Necrotising enterocolitis (NEC), a feared neonatal gastrointestinal inflammatory disease with high mortality and morbidity, is growing in global relevance as birth rates and early survival of low gestational age (GA) infants increases. Population data are scant and pathogenesis is incompletely understood but enteral feed exposures are believed to influence risk. Methods:We conducted a two-year national surveillance study to quantify the total population burden of severe NEC (confirmed at laparotomy and/or leading to death) in England, and a propensity score analysis of the impact of early feeds of maternal milk (MM), and avoidance of bovine-origin formula (BOF) and milk fortifier (BMF), on NEC risk in very preterm infants. Findings:During the study period 118,073 infants (14,678 <32w GA) were admitted to 163 neonatal units across 23 networks; 531 (462 <32w GA) developed severe NEC; 247 died, 139 following laparotomy. Among infants <32w GA the adjusted network incidence ranged from 2·51% to 3·85% with no evidence of unusual variation in relation to the national incidence of 3·13% (95%CI 2·85, 3·42) despite variation in feeding practices. Also among infants <32w GA, commencing any MM within seven postnatal days resulted in an Absolute Risk Difference (ARD) of -0·88% (95% CI -1·15, -0·61), Relative Risk (RR) 0·69 (95% CI 0·60, 0·78), and Number Needed to Treat (NNT) 114 (95% CI 87, 136); equivalent figures for infants receiving no, compared to any bovine-origin products within 14 postnatal days were ARD -0·65% (95% CI -1·01, -0·29), RR 0·61 (95% CI 0·39, 0·83), NNT 154 (95% CI 94, 345). Interpretation:Commencing MM early and avoiding bovine-origin products may reduce NEC but absolute risk reductions appear small. The rarity of severe NEC requires national and international collaboration for adequately powered preventive trials.Funding: This study represents independent research funded by the National Institute for Health Research (NIHR). Research in contextEvidence before this study Necrotising enterocolitis (NEC) is a feared, acute neonatal gastrointestinal inflammatory disease with high mortality and morbidity. Reliable population incidence data are necessary for designing preventive and treatment studies. Enteral feeding stratagems are widely believed to influence NEC risk. When maternal milk (MM) is insufficient or unavailable some clinicians prefer pasteurised human donor milk (HDM) over bovine-origin formula (BOF) in the hope that avoidance of bovine-origin products will be protective and/or pasteurised HDM will retain some of the protective properties of MM. Others prefer BOF to HDM as the composition of the former is consistent, nutrient density is higher, and costs are lower. Other uncertainties relate to the timing of introduction of milk feeds in very preterm infants, and use of bovineorigin fortifier (BMF) (additional vitamins, minerals, and nutrients added to human milk).We conducted a systematic search of studies from the 34 countries in the Organisation fo...

show abstract

“…In populations not restricted to a particular range of gestational age or birth weight, mortality rates of 12 to 38,5% have been reported 25,28,84,85,140,201,207,208 with seemingly lower rates in later publication years. After surgical treatment, mortality may be considerably higher.…”

Section: Outcomementioning

confidence: 99%

Necrotising Enterocolitis - epidemiology and imaging

Ahle¹

View full text Add to dashboard Cite

Effect of Deregionalized Care on Mortality in Very Low-Birth-Weight Infants With Necrotizing Enterocolitis

Abstract: These findings represent an immediate opportunity for local quality improvement initiatives and potential impetus for the regionalization of important NICU resources.

Cited by 73 publications

References 32 publications

Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review

Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review

Incidence and enteral feed antecedents of severe neonatal necrotising enterocolitis across neonatal networks in England, 2012–13: a whole-population surveillance study

Necrotising Enterocolitis - epidemiology and imaging

Contact Info

Product

Resources

About