Perinatal risk factors for necrotizing enterocolitis.

Yu, V. Y. H.; Joseph, R; Bajuk, Barbara; Orgill, A. A.; Astbury, Jill

doi:10.1136/adc.59.5.430

Cited by 77 publications

(41 citation statements)

References 21 publications

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“…[1][2][3][4][5][6][7][8][9][10] Specifically, Laptook et al 3 showed that for every degree decrease in temperature below 36.5°C, mortality increased by 28%. Regarding morbidity, observational studies have reported an association between hypothermia at birth and surfactant unresponsiveness in infants with RDS, subsequent intraventricular hemorrhage, and lateonset sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10] The immature infant is at high risk of net heat loss because of a high surface area to volume ratio and increased evaporative fluid losses from the skin. 11 Strategies introduced to minimize heat loss include occlusive wrapping, exothermic warming mattresses, warmed humidified resuscitation gases, polyethylene caps, and higher delivery room (DR) temperatures.…”

Section: Discussionmentioning

confidence: 99%

“…33 Investigators have evaluated different interventions, predominantly in VLBW infants ,1500 g or a GA ,30 weeks, to prevent heat loss, including using occlusive wrap, exothermic mattresses, warm caps, polyethylene caps, or heated humidified air or raising the OR temperature either singularly or in combination, with varied success. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Because of baseline data demonstrating frequent hypothermia in the larger premature infant, the combination approach of wrap, exothermic mattress, and cap was extended to all infants ,35 weeks old. Indeed, the greatest impact of the QI was noted in these infants.…”

Section: Discussionmentioning

confidence: 99%

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Reducing Hypothermia in Preterm Infants Following Delivery

et al. 2014

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BACKGROUND: Moderate hypothermia (temperature ,36°C) at birth is common in premature infants and is associated with increased mortality and morbidity.METHODS: A multidisciplinary practice plan was implemented to determine in premature infants ,35 weeks old whether a multifaceted approach would reduce the number of inborn infants with an admitting axillary temperature ,36°C by 20% without increasing exposure to a temperature .37.5°C. The plan included use of occlusive wrap a transwarmer mattress and cap for all infants and maintaining an operating room temperature between 21°C and 23°C. Data were obtained at baseline (n = 66), during phasing in (n = 102), and at full implementation (n = 193).RESULTS: Infant axillary temperature in the delivery room (DR) increased from 36.1°C 6 0.6°C to 36.2°C 6 0.6°C to 36.6°C 6 0.6°C (P , .001), and admitting temperature increased from 36.0°C 6 0.8°C to 36.3°C 6 0.6°C to 36.7°C 6 0.5°C at baseline, phasing in, and full implementation, respectively (P , .001). The number of infants with temperature ,36°C decreased from 55% to 6.2% at baseline versus full implementation (P , .001), and intubation at 24 hours decreased from 39% to 17.6% (P = .005). There was no increase in the number of infants with a temperature .37.5°C over time. The use of occlusive wrap, mattress, and cap increased from 33% to 88% at baseline versus full implementation. Control charts showed significant improvement in DR ambient temperature at baseline versus full implementation. CONCLUSIONS:The practice plan was associated with a significant increase in DR and admitting axillary infant temperatures and a corresponding decrease in the number of infants with moderate hypothermia. There was an associated reduction in intubation at 24 hours. These positive findings reflect increased compliance with the practice plan. Dr Russo helped develop the practice plan and the algorithms, helped collect and oversee the data, and was involved in writing the manuscript; Ms McCready and Ms Venturini helped develop the practice plan and the algorithms and were involved in writing the manuscript; Ms Torres helped develop the practice plan and the algorithms, facilitated temperature regulation of the operating room and implementation of the practice plan in labor and delivery, and was involved in writing the manuscript; Ms Theuriere helped develop the practice plan and the algorithms and in review of the data and was involved in writing the manuscript; Dr Spaight helped in the data collection and was involved in writing the manuscript; Ms Hemway helped develop the practice plan and collect data and was involved in writing the manuscript; Ms Handrinos helped develop the practice plan; Ms Perlmutter and Drs Huynh and Grunebaum helped develop the practice plan and were involved in writing the manuscript; Dr Perlman was involved in developing and implementing the practice plan, conceptualized and designed the study, contributed to design of the analyses and interpretation of the results, and took the lead in drafting the init...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reducing Hypothermia in Preterm Infants Following Delivery

et al. 2014

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“…[1][2][3][4][5] The World Health Organization (WHO) established criteria for assessing hypothermia and published a guidebook on the thermal protection of newborns in 1997, indicating that this issue is a worldwide problem even for term infants, particularly in developing nations. 6 WHO classifications of hypothermia are (1) cold stress or mild hypothermia: 36.0 to 36.4 1C (96.8 to 97.51 F); (2) moderate hypothermia: 32.0 to 35.9 1C (89.6 to 96.61 F); and (3) severe hypothermia: below 32 1C (<89.61 F).…”

Section: Introductionmentioning

confidence: 99%

Hypothermia in very low birth weight infants: distribution, risk factors and outcomes

2011

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Objective: The objective of this study was to study the epidemiology of neonatal hypothermia in preterm infants using World Health Organization (WHO) temperature criteria. Result: In all, 56.2% of infants were hypothermic. Low birth weight, cesarean delivery and a low Apgar score were associated with hypothermia. Spontaneous labor, prolonged rupture of membranes and antenatal steroid administration were associated with decreased risk of hypothermia. Moderate hypothermia was associated with higher risk of intraventricular hemorrhage (IVH). Moderate and severe hypothermic conditions were associated with risk of death. Conclusion:Hypothermia by WHO criteria is prevalent in VLBW infants and is associated with IVH and mortality. Use of WHO criteria could guide the need for quality improvement projects targeted toward the most vulnerable infants.

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“…However, Caplan et al (21) reported that hypoxia-reoxygenation may cause intestinal tract injury, but it hardly induces typical NEC in rats. Furthermore, recent clinical findings have demonstrated that perinatal asphyxia does not enhance the NEC morbidity rate (22)(23)(24). Doppler studies of antenatal intestinal blood flow have also not supported a greater likelihood of stage 2 or 3 NEC in infants who had lower blood flows (25).…”

Section: A B C D Discussionmentioning

confidence: 99%

Establishment and evaluation of three necrotizing enterocolitis models in premature rats

Wei

2011

Mol Med Report

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Abstract. Necrotizing enterocolitis (NEC) is a gastrointestinal disease that usually affects premature infants and has high morbidity and mortality rates. Reliable animal models aid further study of the etiological factors, pathogenesis, prevention and treatment of NEC. The present study aimed to establish NEC models in premature rats using three common methods, and to determine the optimal model establishment method. The study consisted of six groups; in group A, rats were raised with simulated milk and subjected to inhalation of 100% nitrogen gas (hypoxia) for 90 sec, followed by exposure to cold ambient conditions (4˚C) for 10 min twice daily for 3 days. In group B, rats were exposed to 100% nitrogen gas for 5 min and 100% oxygen for 5 min twice daily for 3 days. Group C rats were intraperitoneally administered 5 mg/kg lipopolysaccharide. Group D and E rats did not receive any intervention. Group F rats were intraperitoneally administered 1 ml/kg physiological saline. Groups D-F served as the control groups corresponding to groups A-C, respectively. Following hematoxylin and eosin staining, intestinal tract, liver, lung and kidney tissues were observed under optical microscopy and were scored. Successful NEC induction was measured by a score of ≥2. Rats from groups A-C exhibited reduced movement, abdominal distention, diarrhea, intestinal tract expansion, and congestion to varying degrees. The pathological scores of intestinal injury in groups A-F were 3.13±0.64, 1.40±0.52, 2.00±0.42, 0.30±0.48, 0.30±0.48, and 0.40±0.52 points, respectively. Significant differences were found between the model groups and their corresponding control groups (p<0.01). Among the model groups, the histological score of group A was higher than that of groups B (p<0.01) and C (p<0.05). The morbidity rate of NEC in groups A-C was 75, 20 and 50%, respectively. There was no morbidity in groups D-F.Compared with groups A and B, injury to the liver, kidney and lung was more severe in group C. Similar symptoms were not observed in groups D-F. Compared with methods of simple hypoxia-reoxygenation or intraperitoneal administration of lipopolysaccharide, the combination of artificial feeding and hypoxia plus cold stimulation most resembles the pathological causes of neonatal NEC. This method resulted in high morbidity, reproducibility and specificity, and was therefore considered an ideal model for establishing NEC.

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Perinatal risk factors for necrotizing enterocolitis.

Cited by 77 publications

References 21 publications

Reducing Hypothermia in Preterm Infants Following Delivery

Reducing Hypothermia in Preterm Infants Following Delivery

Hypothermia in very low birth weight infants: distribution, risk factors and outcomes

Establishment and evaluation of three necrotizing enterocolitis models in premature rats

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