Necrotizing enterocolitis: current understanding of the prevention and management

Hu, Xiaohan; Liang, Hansi; Li, Fang; Zhang, Rui; Zhu, Yanbo; Zhu, Xueping; Xu, Yunyun

doi:10.1007/s00383-023-05619-3

Cited by 8 publications

(2 citation statements)

References 179 publications

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“…The incidence of NEC in this study was within the current prevalence at 6.9% [54]. As with other studies [55], we found racial disparities amongst our NEC cases, with BPT infants having a higher incidence of NEC at 7.5% versus WPT infants at 6.5% (p = 0.7545).…”

Section: Discussionsupporting

confidence: 86%

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018–2023 in Southeastern US

Dail,

Everhart,

Iskersky

et al. 2024

TropicalMed

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Background: The birthrate of Black preterm (BPT) infants is 65% higher than White preterm (WPT) infants with a BPT mortality that is 2.3 times higher. The incidence of culture-positive late-onset sepsis is as high as 41% in very-preterm infants. The main purpose of this study was to examine thermal gradients and the heart rate in relation to the onset of infection. This report presents disparities in very-preterm infection incidence, bacteria, and mortality data amongst BPT and WPT infants. Methods: 367 preterms born at <32 weeks gestational age (GA) between 2019–2023 in five neonatal intensive care units (NICUs) were enrolled to study the onset of infections and dispositions; REDCap data were analyzed for descriptive statistics. Results: The 362 infants for analyses included 227 BPTs (63.7%) and 107 WPTs (29.6%), with 28 infants of other races/ethnicities (Hispanic, Asian, and other), 50.6% female, mean GA of 27.66 weeks, and 985.24 g birthweight. BPT infants averaged 968.56 g at birth (SD 257.50), and 27.68 (SD 2.07) weeks GA, compared to WPT infants with a mean birthweight of 1006.25 g (SD 257.77, p = 0.2313) and 27.67 (SD 2.00, p = 0.982) weeks GA. Of the 426 episodes of suspected infections evaluated across all the enrolled infants, the incidence of early-onset sepsis (EOS) was 1.9%, with BPT infants having 2.50 times higher odds of EOS than WPT infants (p = 0.4130, OR (odds ratio) = 2.50, p_or = 0.408). The overall incidence of late-onset sepsis (LOS) was 10.8%, with LOS in 11.9% of BPT infants versus 9.3% (p = 0.489, OR = 1.21, p_or = 0.637) of WPT infants. BPT infants made up 69.2% of the 39 infants with Gram-positive infections vs. 25.6% for WPT infants; 16 infants had Gram-negative culture-positive infections, with 81.2% being BPT infants versus 18.8% being WPT infants. Of the 27 urinary tract infections, 78% were in BPTs. The necrotizing enterocolitis incidence was 6.9%; the incidence in BPT infants was 7.5% vs. 6.5% in WPT infants. The overall mortality was 8.3%, with BPTs at 8.4% vs. WPT infants at 9.3%, (p = 0.6715). Conclusions: BPTs had a higher rate of positive cultures, double the Gram-negative infections, a much higher rate of urinary tract infections, and a higher rate of mortality than their WPT counterparts. This study emphasizes the higher risk of morbidity and mortality for BPTs.

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Section: Discussionsupporting

confidence: 86%

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018–2023 in Southeastern US

Dail,

Everhart,

Iskersky

et al. 2024

TropicalMed

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“…Necrotizing enterocolitis (NEC) is a complex inflammatory gastrointestinal disease with devastating sequelae (1). Despite decades of research to identify predisposing factors and effective treatments, NEC remains a leading cause of morbidity and mortality in neonatal intensive care units, especially in low birth weight infants (2). Related mortality rates remain unacceptably high, surpassing 50% in affected infants requiring surgery for NEC (3).…”

Section: Introductionmentioning

confidence: 99%

Chromatin as alarmins in necrotizing enterocolitis

Nofi,

Prince,

Wang

et al. 2024

Front. Immunol.

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Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease primarily affecting premature neonates, marked by poorly understood pro-inflammatory signaling cascades. Recent advancements have shed light on a subset of endogenous molecular patterns, termed chromatin-associated molecular patterns (CAMPs), which belong to the broader category of damage-associated molecular patterns (DAMPs). CAMPs play a crucial role in recognizing pattern recognition receptors and orchestrating inflammatory responses. This review focuses into the realm of CAMPs, highlighting key players such as extracellular cold-inducible RNA-binding protein (eCIRP), high mobility group box 1 (HMGB1), cell-free DNA, neutrophil extracellular traps (NETs), histones, and extracellular RNA. These intrinsic molecules, often perceived as foreign, have the potential to trigger immune signaling pathways, thus contributing to NEC pathogenesis. In this review, we unravel the current understanding of the involvement of CAMPs in both preclinical and clinical NEC scenarios. We also focus on elucidating the downstream signaling pathways activated by these molecular patterns, providing insights into the mechanisms that drive inflammation in NEC. Moreover, we scrutinize the landscape of targeted therapeutic approaches, aiming to mitigate the impact of tissue damage in NEC. This in-depth exploration offers a comprehensive overview of the role of CAMPs in NEC, bridging the gap between preclinical and clinical insights.

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Maternal chorioamnionitis and the risk for necrotizing enterocolitis in the United States: A national cohort study

Farghaly,

Alzayyat,

Kassim

et al. 2024

Early Human Development

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Necrotizing enterocolitis: current understanding of the prevention and management

Cited by 8 publications

References 179 publications

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018–2023 in Southeastern US

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018–2023 in Southeastern US

Chromatin as alarmins in necrotizing enterocolitis

Maternal chorioamnionitis and the risk for necrotizing enterocolitis in the United States: A national cohort study

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