Serious Congenital Heart Disease and Necrotizing Enterocolitis in Very Low Birth Weight Neonates

Fisher, Jeremy G.; Bairdain, Sigrid; Sparks, Eric A.; Khan, Faroque A.; Archer, Jeremy M.; Kenny, Michael; Edwards, Erika M.; Soll, Roger F.; Modi, Biren P.; Yeager, Scott B.; Horbar, Jeffrey D.; Jaksic, Tom

doi:10.1016/j.jamcollsurg.2014.11.026

Cited by 60 publications

(37 citation statements)

References 33 publications

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“…Motta et al [ 20 ] reported similar rates of congenital heart disease and that the infants in their population also had many associated illness and anomalies. [ 21 ] It is possible that more of hypoxic cardiac defects, associated with NEC patients, would place them at a higher risk for intestinal hypoperfusion, which might predispose infants to development NEC and the following complication. Although not proven, we speculated that late-onset NEC may lead to an increased cytokine response and, subsequently, adverse hospital outcomes.…”

Section: Discussionmentioning

confidence: 99%

Postoperative characteristics of infants who developed necrotizing enterocolitis with different postnatal ages

Wang

et al. 2017

Medicine

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Our goal was to investigate the surgical procedures, postoperative complications, and survival with regard to different onset timing of necrotizing enterocolitis (NEC).We performed a retrospective review of medical records with a diagnosis of NEC between 2005 and 2016. The cutoff was set at 10 days for early onset ≤10 days and late onset over 10 days. Propensity score matching was performed to adjust for any baseline differences. In 53 paired patients, clinical outcomes, including, mortality, postoperative complications, and length of neonatal intensive care unit (NICU) stay, were evaluated on the basis of early or late-onset NEC.Successful 1:1 matching propensity score matching was performed with 208 infants. Mortality for early-onset NEC infants was lower than that of early late NEC infants (P = .026). A lower overall postoperative complication rate, including infectious complications [19 (35.8) vs 29 (54.7); odds ratio, 0.462, confidence interval (CI) 0.212–1.008, P = .039], was noted in patients with early-onset NEC compared with infants with late-onset NEC. NICU stay and major complication were marginal different between the 2 groups. Comparison of feeding outcomes revealed that the time to achieve full enteral feeds was significantly longer for those with late-onset NEC (18.1 ± 11.5 vs 26.3 ± 15.6, P = .008).The infants who develop NEC after 10 days of life do influence postoperative outcome survival or other clinically important outcomes after laparotomy.

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Section: Discussionmentioning

confidence: 99%

Postoperative characteristics of infants who developed necrotizing enterocolitis with different postnatal ages

Wang

et al. 2017

Medicine

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“…Wei et al [44] reported that a weight over 2.4 kg at the time of cardiovascular surgery was associated with lower rates of postoperative infections. Fisher et al [45] concluded that infants with serious congenital heart disease (CHD) appear to be at increased risk for necrotizing enterocolitis (NEC). The incidence of NEC is significantly higher in very low birth weight neonates when CHD is present.…”

Section: Discussionmentioning

confidence: 99%

Prediction of spontaneous closure of isolated ventricular septal defects in utero and postnatal life

Song

et al. 2016

BMC Pediatr

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BackgroundVentricular septal defect (VSD) is a highly prevalent fetal congenital heart defect, which can become spontaneously closed during infancy. The current study aims to characterize fetal VSDs that were subsequently spontaneously closed in the first 2 years of life in eastern China.MethodsBetween January 2011 and December 2013, 257 fetal patients diagnosed with isolated VSD by fetal echocardiography at Nanjing Maternity and Child Health Care Hospital, China, were enrolled in the study. Subjects were divided into three groups: group 1 = persistent VSD; group 2 = closed after birth; group 3 = closed during gestation. Fetal echocardiography data, physical features at birth and follow-up outcomes for 2 years were compared to identify factors contributing to spontaneous closure (SC) of VSD. A predictive formula was applied to patients admitted to hospital in the first quarter of 2014 (n = 23) for validation.ResultsSC occurred in 42.8% patients. Birth weight (3.095 ± 0.774, 3.174 ± 0.535, 3.499 ± 0.532 kg in groups 1, 2 and 3, respectively) and defect diameter (3.422 ± 0.972, 2.426 ± 0.599, 2.292 ± 0.479 mm, in groups 1, 2 and 3, respectively) showed statistically significant differences between the three groups (P = 0.004 and P = 0.000, respectively). Receiver operating characteristic (ROC) curves identified cut-off value for the defect diameter as 2.55 mm, and logistic regression analysis identified the SC probability = (1 + exp -[-2.151 − 0.716*birth weight + 1.393*diameter])-1. Results indicated that male fetuses, full-term birth, muscular VSD, and defects without blood flow crossing the septum, have higher incidence of SC.ConclusionsThe major determinants of SC of isolated VSD are birth weight and diameter of the defect. In addition, VSD location may also affect the SC incidence.

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“…In addition, term neonates with NEC often have conditions such as chronic heart disease that favour hypoxic or ischaemic states (Fig. 2a) (Refs 31, 32). However, no primary hypoxic–ischaemic event can be identified in most preterm infants presenting with NEC.…”

Section: Nec Pathogenesis and Risk Factorsmentioning

confidence: 99%

The immunological landscape in necrotising enterocolitis

Cho

Berger

Nold-Petry

et al. 2016

Expert Rev. Mol. Med.

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Necrotising enterocolitis (NEC) is an uncommon, but devastating intestinal inflammatory disease that predominantly affects preterm infants. NEC is sometimes dubbed the spectre of neonatal intensive care units, as its onset is insidiously non-specific, and once the disease manifests, the damage inflicted on the baby's intestine is already disastrous. Subsequent sepsis and multi-organ failure entail a mortality of up to 65%. Development of effective treatments for NEC has stagnated, largely because of our lack of understanding of NEC pathogenesis. It is clear, however, that NEC is driven by a profoundly dysregulated immune system. NEC is associated with local increases in pro-inflammatory mediators, e.g. Toll-like receptor (TLR) 4, nuclear factor-κB, tumour necrosis factor, platelet-activating factor (PAF), interleukin (IL)-18, interferon-gamma, IL-6, IL-8 and IL-1β. Deficiencies in counter-regulatory mechanisms, including IL-1 receptor antagonist (IL-1Ra), TLR9, PAF-acetylhydrolase, transforming growth factor beta (TGF-β)1&2, IL-10 and regulatory T cells likely facilitate a pro-inflammatory milieu in the NEC-afflicted intestine. There is insufficient evidence to conclude a predominance of an adaptive Th1-, Th2- or Th17-response in the disease. Our understanding of the accompanying regulation of systemic immunity remains poor; however, IL-1Ra, IL-6, IL-8 and TGF-β1 show promise as biomarkers. Here, we chart the emerging immunological landscape that underpins NEC by reviewing the involvement and potential clinical implications of innate and adaptive immune mediators and their regulation in NEC.

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Serious Congenital Heart Disease and Necrotizing Enterocolitis in Very Low Birth Weight Neonates

Cited by 60 publications

References 33 publications

Postoperative characteristics of infants who developed necrotizing enterocolitis with different postnatal ages

Postoperative characteristics of infants who developed necrotizing enterocolitis with different postnatal ages

Prediction of spontaneous closure of isolated ventricular septal defects in utero and postnatal life

The immunological landscape in necrotising enterocolitis

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