National prospective surveillance study of necrotizing enterocolitis in neonatal intensive care units

Rees, Clare M.; Eaton, Simon; Pierro, Agostino

doi:10.1016/j.jpedsurg.2009.12.002

Cited by 79 publications

(45 citation statements)

References 25 publications

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“…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. The finding that infants of lower GA develop NEC at a later postnatal age is also in accord with other studies [33][34][35] including the Probiotic in Preterms trial (PiPs) conducted in the south-east of England.…”

supporting

confidence: 86%

“…We secured the participation of every neonatal unit in England and hence were able to ascertain the exact number of cases of severe NEC. Incomplete ascertainment is a common limitation of other studies 22,23 compounded by selection bias when confined to tertiary referral centres. We applied a stringent definition and confirmed each case with clinical teams to minimise contamination from other diagnoses, such as spontaneous intestinal perforation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

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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...

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supporting

confidence: 86%

Section: Discussionmentioning

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

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“…This second surgical procedure was performed for more than one-half of the patients in this data set, which is consistent with the range reported in the literature (22%-74%). [15][16][17]19,24,29,30 The known drivers of surgical costs in infants who underwent peritoneal drainage followed by laparotomy include increased length of stay 19 and postdrainage clinical decompensation. 15,31 The present study was limited by the administrative nature of the data set.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

et al. 2015

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BACKGROUND AND OBJECTIVES: Despite previous studies demonstrating no difference in mortality or morbidity, the various surgical approaches for necrotizing enterocolitis (NEC) in infants have not been evaluated economically. Our goal was to compare total in-hospital cost and mortality by using propensity score-matched infants treated with peritoneal drainage alone, peritoneal drainage followed by laparotomy, or laparotomy alone for surgical NEC. RESULTS: Successful propensity score matching was performed with 699 infants (peritoneal drainage, n = 101; peritoneal drainage followed by laparotomy, n = 172; and laparotomy, n = 426). Average adjusted cost for peritoneal drainage followed by laparotomy was $ CONCLUSIONS: Propensity score-matched analysis of surgical NEC treatment found that peritoneal drainage followed by laparotomy was associated with decreased mortality compared with peritoneal drainage alone but at significantly increased costs. WHAT'S KNOWN ON THIS SUBJECT:Mortality rates and health care expenditures are high among infants requiring surgery for necrotizing enterocolitis. The impact of different surgical managements on mortality remains equivocal. Adjusted economic differences for various surgical treatments may exist but have not been elucidated. WHAT THIS STUDY ADDS:After performing a relatively large-scale, adjusted analysis of cost and mortality for surgical managements currently used for treating necrotizing enterocolitis, a costbenefit for a particular surgical approach was demonstrated while accounting for comorbidities and group assignment bias.

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“…The nature of the enteral feed seems to be an important pathogenic factor. Epidemiological studies have suggested an increased risk of NEC in cow's milk formula-fed infants when compared with those receiving breast milk (maternal or donor) (6). To date, the potential link between NEC and formula milk has mostly been explored through identifying the immunoprotective elements in breast milk and the determining effect of milk type (formula or breast) on the development of the intestinal microbiota (7).…”

mentioning

confidence: 99%

In Vitro Cow's Milk Protein-Specific Inflammatory and Regulatory Cytokine Responses in Preterm Infants With Necrotizing Enterocolitis and Sepsis

et al. 2011

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Enteral feeding with cow's milk formula is associated with neonatal necrotizing enterocolitis (NEC) and sepsis. Dietary antigen sensitization may play a role in promoting and/or sustaining inflammation in both conditions. Aiming at investigating cow's milk protein (CMP)-specific cytokine responses in preterm infants with NEC and sepsis, 14 babies with NEC, 14 matched healthy controls, and 10 septic controls were recruited. Unstimulated and stimulated peripheral blood mononuclear cells (PBMCs) secreting IFN-␥, IL-4, IL-10, and TGF-␤1 were counted by the single-cell enzyme-linked immunospot (ELISPOT) assay. During the acute phase of NEC, patients showed a general pattern of a high level of cytokine secretion both when unstimulated and stimulated by mitogen [phytohaemagglutinin (PHA)] and CMPs: beta-lactoglobulin (␤-lg) and casein. These responses were more marked to ␤-lg for IFN-␥, IL-4, and IL-10 than TGF-␤1. Cytokine responses in sepsis were lower than in NEC (lowest in healthy controls, with a minimal TGF-␤1 response). At term, lower frequencies of cytokine-secreting cells were elicited than during the acute phase, except for TGF-␤1 secreting cells, which increased at term (in response to PHA and CMPs) particularly following not only NEC but also sepsis.

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National prospective surveillance study of necrotizing enterocolitis in neonatal intensive care units

Cited by 79 publications

References 25 publications

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

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

Outcomes and Costs of Surgical Treatments of Necrotizing Enterocolitis

In Vitro Cow's Milk Protein-Specific Inflammatory and Regulatory Cytokine Responses in Preterm Infants With Necrotizing Enterocolitis and Sepsis

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