Prevention of Necrotizing Enterocolitis

Neu, Josef

doi:10.1016/j.clp.2021.11.012

Cited by 9 publications

(5 citation statements)

References 91 publications

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“…NEC was defined per the modified Bell criteria, consistent with definitions used by the original Nathan et al QI study. 3 9 10 All patients meeting criteria for Bell Stage II or III NEC or diagnosed with SIP were included in this study. Study subjects were classified as medical NEC (Bell Stage II), surgical NEC (Bell Stage III), or SIP.…”

Section: Methodsmentioning

confidence: 99%

Quality Improvement Efforts Reduce Incidence of Surgical Necrotizing Enterocolitis and Related Deaths

et al. 2020

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Objective The aim of this study was to determine whether a regional quality improvement (QI) initiative decreased incidence and severity of surgical necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. Study Design A retrospective review of all VLBW infants who received care at one of the three hospitals involved in a NEC QI initiative from 2011 to 2016. Primary outcome was the number of surgical NEC cases per year. Secondary outcomes included associated outcomes and mortality. Results Sixty-three infants with either a diagnosis of Stage III NEC (n = 40) or spontaneous intestinal perforation (SIP) (n = 23) were included. The incidence of medical and surgical NEC and the mortality rate of infants with surgical NEC decreased over time. Incidence and mortality of SIP did not significantly change. Conclusion A regional QI bundle to reduce the overall incidence of NEC also significantly decreased the incidence of surgical NEC and all-cause mortality of infants diagnosed with surgical NEC. Key Points

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Section: Methodsmentioning

confidence: 99%

Quality Improvement Efforts Reduce Incidence of Surgical Necrotizing Enterocolitis and Related Deaths

et al. 2020

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“…While the exact mechanisms underlying this exaggerated inflammation remains incompletely understood, prematurity, gut dysbiosis, genetic predisposition, formula-feeding, red blood cell transfusion, and intrauterine growth restriction are considered risk factors (3)(4)(5). Because NEC can develop suddenly, addressing risk factors that are potentially modifiable is a key strategy to prevent NEC and help improve outcomes (6). Antibiotics use in the first two weeks of life has been identified as one such risk factor that can potentially modulate risk for NEC (7).…”

Section: Introductionmentioning

confidence: 99%

Early antibiotics and risk for necrotizing enterocolitis in premature infants: A narrative review

2023

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While prompt initiation of antibiotics at birth due to concerns for early onset sepsis is common, it often leads to many preterm infants being exposed to treatment despite negative blood cultures. Such exposure to early antibiotics can impact the developing gut microbiome putting infants at increased risk of several diseases. Necrotizing enterocolitis (NEC), a devastating inflammatory bowel disease that affects preterm infants, is among the most widely studied neonatal disease that has been linked to early antibiotics. While some studies have demonstrated an increased risk of NEC, other studies have demonstrated seemingly contrary findings of decreased NEC with early antibiotics. Studies using animal models have also yielded differing findings of benefit vs. harm of early antibiotic exposure on subsequent NEC susceptibility. We thus sought to conduct this narrative review to help clarify the relationship between early antibiotics exposure and future risk of NEC in preterm infants. Our objectives are to: (1) summarize findings from human and animal studies that investigated the relationship between early antibiotics and NEC, (2) highlight important limitations of these studies, (3) explore potential mechanisms that can explain why early antibiotics may increase or decrease NEC risk, and (4) identify future directions for research.

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“…Intraventricular hemorrhage (IVH) defined by Papile et al and Bowerman et al, 15 16 and necrotizing enterocolitis (NEC) stage 2 or above based on modified Bell's criteria. 17 Early-onset sepsis (EOS) was positive blood culture within the first 72 hours of life. Retinopathy of prematurity (ROP) stages were defined according to the International Classification of Retinopathy of Prematurity Revisited.…”

Section: Methodsmentioning

confidence: 99%

Effect of Maternal Preeclampsia on Cardiac Structure and Function in Very Low Birth Weight Infants

Kohbodi,

Cayabyab,

Kibe

et al. 2024

Am J Perinatol

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Objective We aimed to determine whether exposure to severe maternal preeclampsia (PE) in very low birth weight (VLBW) infants is associated with hypertrophic cardiac changes and altered hemodynamics. Study Design Case–control study of VLBW infants born at Los Angeles General Medical Center from May 2015 to August 2023, who had an echocardiogram within the first 7 days of life. Cases were infants exposed to maternal PE and controls were infants not exposed to maternal PE matched by birth weight (BW) 1:1. Laboratory, placental pathology results, hemodynamic data and clinical outcomes were collected and compared between cases and control infants. Results A total of 43 cases matched by BW with control infants were studied. There were no significant anatomical cardiac changes by echocardiography between cases and control infants. Cases had significantly higher blood pressure within the first 72 hours of life and lower ejection fraction (EF), fractional shortening, and peak systolic flow velocity through their patent ductus arteriosus (PDA) within the first week of life. Cases were more likely to be smaller despite being born at a later gestational age (GA), as well as small for GA with placental weight less than 10th percentile compared to control infants. Conclusion Our findings indicate that infants born to mothers with PE have higher systemic vascular resistance as evidenced by elevated blood pressure, and lower EF and shortening fraction and higher pulmonary vascular resistance as evidenced by lower peak flow velocity through the PDA. We did not observe hypertrophic cardiac changes in exposed infants. These findings should be considered in clinical decision-making during management of these infants. Key Points

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Prevention of Necrotizing Enterocolitis

Cited by 9 publications

References 91 publications

Quality Improvement Efforts Reduce Incidence of Surgical Necrotizing Enterocolitis and Related Deaths

Quality Improvement Efforts Reduce Incidence of Surgical Necrotizing Enterocolitis and Related Deaths

Early antibiotics and risk for necrotizing enterocolitis in premature infants: A narrative review

Effect of Maternal Preeclampsia on Cardiac Structure and Function in Very Low Birth Weight Infants

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