Trends in incidence and outcomes of necrotizing enterocolitis over the last 12 years: A multicenter cohort analysis

Han, Shasha; Hong, Charles R.; Knell, Jamie; Edwards, Erika M.; Morrow, Kate A.; Soll, Roger F.; Modi, Biren P.; Horbar, Jeffrey D.; Jaksic, Tom

doi:10.1016/j.jpedsurg.2020.02.046

Cited by 81 publications

(51 citation statements)

References 13 publications

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“…approach the disease differently 34 . In this study, we shed light on the possibility that NEC arises from reduced AHR signaling in the intestinal epithelium of the premature infant, and show that AHR ligands may be passed from mother to infant-both during pregnancy via the fetal circulation, and in the postnatal period through the breast milk-where they can then attenuate the severity of this disease.…”

Section: Discussionmentioning

confidence: 99%

Maternal aryl hydrocarbon receptor activation protects newborns against necrotizing enterocolitis

et al. 2021

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Necrotizing enterocolitis (NEC) is a disease of premature infants characterized by acute intestinal necrosis. Current dogma suggests that NEC develops in response to post-natal dietary and bacterial factors, and so a potential role for in utero factors in NEC remains unexplored. We now show that during pregnancy, administration of a diet rich in the aryl hydrocarbon receptor (AHR) ligand indole-3-carbinole (I3C), or of breast milk, activates AHR and prevents NEC in newborn mice by reducing Toll-like receptor 4 (TLR4) signaling in the newborn gut. Protection from NEC requires activation of AHR in the intestinal epithelium which is reduced in mouse and human NEC, and is independent of leukocyte activation. Finally, we identify an AHR ligand (“A18”) that limits TLR4 signaling in mouse and human intestine, and prevents NEC in mice when administered during pregnancy. In summary, AHR signaling is critical in NEC development, and maternally-delivered, AHR-based therapies may alleviate NEC.

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Section: Discussionmentioning

confidence: 99%

Maternal aryl hydrocarbon receptor activation protects newborns against necrotizing enterocolitis

et al. 2021

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“…Around 5 to 10% of very low birth weight (VLBW) infants develop NEC, with the highest incidence among neonates with an extremely low birth weight (ELBW) [2]. Despite advancing medical care, NEC incidence has not substantially decreased over time, mainly due to increased early survival of neonates [3][4][5]. NEC mortality is inversely correlated with birth weight and generally ranges from 15% to 30% [2,6].…”

Section: Introductionmentioning

confidence: 99%

Enteral Feeding Interventions in the Prevention of Necrotizing Enterocolitis: A Systematic Review of Experimental and Clinical Studies

et al. 2021

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Necrotizing enterocolitis (NEC), which is characterized by severe intestinal inflammation and in advanced stages necrosis, is a gastrointestinal emergency in the neonate with high mortality and morbidity. Despite advancing medical care, effective prevention strategies remain sparse. Factors contributing to the complex pathogenesis of NEC include immaturity of the intestinal immune defense, barrier function, motility and local circulatory regulation and abnormal microbial colonization. Interestingly, enteral feeding is regarded as an important modifiable factor influencing NEC pathogenesis. Moreover, breast milk, which forms the currently most effective prevention strategy, contains many bioactive components that are known to support neonatal immune development and promote healthy gut colonization. This systematic review describes the effect of different enteral feeding interventions on the prevention of NEC incidence and severity and the effect on pathophysiological mechanisms of NEC, in both experimental NEC models and clinical NEC. Besides, pathophysiological mechanisms involved in human NEC development are briefly described to give context for the findings of altered pathophysiological mechanisms of NEC by enteral feeding interventions.

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“…NEC is one of the common complications with a high mortality in neonates, particularly in VLBW infants [1,31]. In recent years, studies on the association of anemia, RBC transfusion and NEC have received extensive attention, but the association between them is still not clearly understood.…”

Section: Discussionmentioning

confidence: 99%

The association of severe anemia, red blood cell transfusion and necrotizing enterocolitis in neonates

Shi

Dong

et al. 2021

PLoS ONE

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Background The relationship between severe anemia, red blood cell transfusion and Neonatal necrotizing enterocolitis (NEC) remains controversial. The purpose of this study was to determine the association of severe anemia and RBC transfusion with NEC in neonates. Methods The clinical characteristics of NEC were observed in 467 infants with different birth weights from January 2012 to July 2020. A 1:1 ratio case-control study was performed in very low birth weight (VLBW) infants. Severe anemia, RBC transfusion, and confounding factors, including maternal and perinatal complications, feeding, and antibiotics administration were collected in both groups. Univariate and multivariate analyses were used to investigate effects on the risk of NEC. Results The day of NEC onset and mortality were inversely associated with birth weight. In VLBW infants, adjusting for other factors, severe anemia within 72 h [OR = 2.404, P = 0.016], RBC transfusion within 24 h [OR = 4.905, P = 0.016], within 48 h [OR = 5.587, P = 0.008], and within 72 h [OR = 2.858, P = 0.011] increased the risk of NEC. Conclusion Both severe anemia and RBC transfusion appears to increase the risk of NEC in VLBW infants. The early prevention and treatment of anemia, strict evaluation of the indications for transfusion and enhanced monitoring after transfusion is encouraged in the NICU.

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Trends in incidence and outcomes of necrotizing enterocolitis over the last 12 years: A multicenter cohort analysis

Cited by 81 publications

References 13 publications

Maternal aryl hydrocarbon receptor activation protects newborns against necrotizing enterocolitis

Maternal aryl hydrocarbon receptor activation protects newborns against necrotizing enterocolitis

Enteral Feeding Interventions in the Prevention of Necrotizing Enterocolitis: A Systematic Review of Experimental and Clinical Studies

The association of severe anemia, red blood cell transfusion and necrotizing enterocolitis in neonates

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Trends in incidence and outcomes of necrotizing enterocolitis over the last 12 years: A multicenter cohort analysis

Cited by 81 publications

References 13 publications

Maternal aryl hydrocarbon receptor activation protects newborns against necrotizing enterocolitis

Maternal aryl hydrocarbon receptor activation protects newborns against necrotizing enterocolitis

Enteral Feeding Interventions in the Prevention of Necrotizing Enterocolitis: A Systematic Review of Experimental and Clinical Studies

The association of severe anemia, red blood cell transfusion and necrotizing enterocolitis in neonates

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Trends in incidence and outcomes of necrotizing enterocolitis over the last 12 years: A multicenter cohort analysis