Gastroenteritis with Necrotizing Enterocolitis in Premature Babies

Stein, Harry; Beck, John; Solomon, Albert; Schmaman, A

doi:10.1136/bmj.2.5814.616

Cited by 66 publications

(17 citation statements)

References 9 publications

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“…pathogen-specific NEC) differing greatly. In 1972, Stein et al reported one of the first outbreaks consisting of 11 cases of NEC in a single nursery in South Africa over a 10-week period 10. Chappell and Dinner reported an outbreak involving 20 cases over a 3-week period 29.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology of Necrotizing Enterocolitis Temporal Clustering in Two Neonatology Practices

Meinzen‐Derr

Morrow

Hornung

et al. 2009

The Journal of Pediatrics

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Objective-To develop a statistical method for defining clusters of necrotizing enterocolitis (NEC) cases in the neonatal intensive care unit (NICU).Study design-2782 infants, between 1996-2004, weighing 401-1500 grams at birth were included. NEC was defined as Bell stage II or III. Two statistical methods used to define "disease clusters" were: (1) modified scan test; (2) comparison of observed and expected incidence density rates (IDR) of NEC at each NICU.Results-The proportion of infants with NEC was similar between NICUs (7.1% vs. 7.7%; p=0.6) as was the expected IDR of NEC (1.39/1000 patient-days vs. 1.32/1000 patient-days, p=0.72). Twelve temporal clusters of NEC were identified in the NICUs combined, comprising 18% of 203 total NEC cases during the study period. No seasonal/secular trends were noted for NEC rates or identified clusters. Potential NEC clusters of ≥3 cases at either NICU had >75% chance of being a true NEC cluster.Conclusions-No operational definition of NEC cluster exists. This study introduced methods to be employed for prospective surveillance and guide studies to investigate etiologic relevance. Utilizing the proposed methods, statistically significant clusters (potential outbreaks) of NEC within NICUs can be identified early, providing early opportunity to implement cluster investigation protocols. Keywords disease clusters; outbreaks; neonatal intensive care unit; very low birth weight infantsCorresponding Author: Jareen Meinzen-Derr, Ph.D., 3333 Burnet Ave, MLC 5041, Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, Email: E-mail: jareen.meinzen-derr@cchmc.org. Edited by Padbury and WFBThe authors declare no conflicts of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Necrotizing enterocolitis (NEC), the most common gastrointestinal emergency in the neonatal intensive care unit (NICU), is a sudden-onset life-threatening disease that occurs primarily in preterm infants. NEC affects approximately 6-10% of very low birthweight (VLBW) infants, 1-4 with nearly 90% of all NEC cases occurring among this population and a case-fatality rate as high as 20-40%. 5 The etiology of NEC is not clearly established, but appears to be multifactorial, involving enteral feeding, vascular or perfusion-related gastrointestinal compromise, and bacterial invasion. 6, 7 Cases appear to occur sporadically with reports of clusters or outbreaks. 8, 9 No formal or consistent approach has been applied to these reports, however, regarding the definition and timing of apparent outbreaks or the...

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Section: Discussionmentioning

confidence: 99%

“…No formal or consistent approach has been applied to these reports, however, regarding the definition and timing of apparent outbreaks or the cases associated with them. The case definition applied during outbreak investigations has often included suspected NEC and gastroenteritis cases, with outbreak durations of 8 to 10 weeks 10–21…”

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confidence: 99%

Epidemiology of Necrotizing Enterocolitis Temporal Clustering in Two Neonatology Practices

Meinzen‐Derr

Morrow

Hornung

et al. 2009

The Journal of Pediatrics

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“…Mizrahi and colleagues in NYC cultured blood and peritoneal fluid from patients with disease and demonstrated a predilection for Gram negative bacteria, particularly E. Coli as offending agents associated with NEC 12 . Additional studies in the early 1970’s showed that ‘epidemics’ of NEC occurred in some NICU’s, and in one of the first reports, Stein et al showed that Salmonella organisms were involved in 11 consecutive cases 13 . Nonetheless, many cases of NEC were not associated with bacterial organisms in the blood, and further investigation suggested that intestinal bacteria might initiate NEC by activating the inflammatory response.…”

Section: Effect Of Microbiomementioning

confidence: 99%

Necrotizing enterocolitis: Pathophysiology from a historical context

Hackam

Caplan

2018

Seminars in Pediatric Surgery

122

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Necrotizing Enterocolitis (NEC) continues to afflict approximately 7% of preterm infants born weighing less than 1500 grams, though recent investigations have provided novel insights into the pathogenesis of this complex disease1. The disease has been a major cause of morbidity and mortality in neonatal intensive care units worldwide for many years, and our current understanding reflects exceptional observations made decades ago. In this review, we will describe NEC from a historical context and summarize seminal findings that underscore the importance of enteral feeding, the gut microbiota, and intestinal inflammation in this complex pathophysiology.

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“…This was emphasized by Lloyd (1969) as an important etiology of gastroi.ntestinal perforations of the newborn infant. The high incidence of infection found in NEC has been reported by many authors which is mostly caused by gram-negative microorganisms such as, Salmonella (Stein et al, 1972), Klebsiella (Hill et al,, and E. coli (Speer et al, 1976). These implicate enteric bacteria in 1he pathogenesis of the disease.…”

Section: Et!iology and Pathogenes·1smentioning

confidence: 96%

Neonatal Necrotizing Enterocolitis

Tjandra

2017

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Neonatal Necrotizing Enterocolitis (NEC) is a highly lethal disease of the newborn infant, which has aroused great interest in the past decades. It is characterized by ischemic necrosis of th'e intestinal wall, frequ®tly /'{fading to perforation and death. Unlike most neonatal emergencies, it is acquired and can be wccessfully treated without op,eration in most cas(!S.The etiology is still obscure and is considered to be multifactorial. Intesti11al ischemi.a, infections, cow's milk, and hyperosmolar

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Gastroenteritis with Necrotizing Enterocolitis in Premature Babies

Cited by 66 publications

References 9 publications

Epidemiology of Necrotizing Enterocolitis Temporal Clustering in Two Neonatology Practices

Epidemiology of Necrotizing Enterocolitis Temporal Clustering in Two Neonatology Practices

Necrotizing enterocolitis: Pathophysiology from a historical context

Neonatal Necrotizing Enterocolitis

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