scholarly journals Predictive factors for the surgical treatment of necrotizing enterocolitis in preterm infants: a single-center retrospective study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Yusheng Liu ◽  
Lingyan Qiao ◽  
Xiongwei Wu ◽  
Zhong Jiang ◽  
Xiwei Hao
Keyword(s):  
Surgical Treatment ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Multivariate Analyses ◽  
Gastrointestinal Disease ◽  
Ductus Arteriosus ◽  
Clinical Manifestations ◽  
Serum Bicarbonate ◽  
Early Occurrence

Abstract Background Necrotizing enterocolitis (NEC) is a gastrointestinal disease that tends to occur in premature infants. Some features may be associated with an increased probability that preterm infants with NEC will require surgical treatment. This study aimed to identify the factors that increased the probability of surgical treatment in infants with NEC. Methods We retrospectively analyzed the data of premature infants with NEC who were hospitalized at The Affiliated Hospital of Qingdao University from April 2011 to April 2021. According to the treatments received, these patients were divided into medical NEC group and surgical NEC group. The perinatal characteristics, clinical manifestations, and laboratory values before the onset of NEC were subjected to univariate and multivariate analyses. Results A total of 623 preterm infants with NEC (> Bell’s stage I) were included in this study, including 350 (56%) who received surgical treatment and 273 (44%) who received conservative medical treatment. Multivariate analysis showed that lower gestational age (P = 0.001, odds ratio (OR) (95% CI) = 0.91[0.86–0.96]), early occurrence of NEC (P = 0.003, OR (95% CI) = 0.86 [0.77–0.95]), hemodynamically significant patent ductus arteriosus (P = 0.003, OR (95% CI) = 7.50 [2.03–28.47]), and low serum bicarbonate (P = 0.043, OR (95% CI) = 0.863 [0.749–0.995]) were associated with an increased probability of surgical treatment in preterm infants with NEC. Conclusions Our findings were applied to identify potential predictors for surgical treatment in preterm infants with NEC, which may facilitate early decisive management.

scholarly journals ORAL VERSUS INTRAVENOUS IBUPROFEN FOR THE EARLY CLOSURE OF PATENT DUCTUS ARTERIOSUS IN LOW BIRTH WEIGHT PRETERM INFANTS

2013 ◽  
Vol 6 ◽  
Author(s):  
Alketa Hoxha ◽  
Ermira Kola ◽  
Numila Kuneshka ◽  
Eduard Tushe
Keyword(s):  
Birth Weight ◽  
Adverse Effects ◽  
Preterm Infants ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Ductal Closure ◽  
Oral Ibuprofen ◽  
Intravenous Ibuprofen ◽  
Ibuprofen Group ◽  
Patent Ductus

Background Patent ductus arteriosus (PDA) is common in very premature infants. Pharmacological closure of PDA with indomethacin, a prostaglandin inhibitor, has remained the mainstay of treatment in premature infants over the last three decades. Intravenous ibuprofen was recently shown to be as effective and to have fewer adverse reaction in preterm infants. If equally effective, then oral ibuprofen for PDA closure would have several important advantages over the intravenous route.This study was designed to assess the efficacy and safety of oral ibuprofen and intravenous ibuprofen for the early pharmacological treatment of PDA in LBW preterm infants with respiratory distress syndrome.MethodsA randomized, single-blinded, controlled study was performed on premature neonates at the neonatal care unit of the University Hospital for Obstetrics and Gynecology”Koco Gliozheni”, Tirana, Albania, from January 2010 to December 2012. The study enrolled 68 preterm infants with gestational age between 28-32 weeks, birth weight ≤ 2000 g, postnatal age 48-96 h, and had echocardiographically confirmed significant PDA. The preterm infants received either intravenous or oral ibuprofen randomly as an initial dose of 10 mg/kg, followed by 5 mg/kg at 24 and 48 h. After the first dose of treatment in both groups, echocardiographic evaluation was performed, to determine the need for a second or third dose. The rate of ductal closure, adverse effects, complications, and the patient’s clinical course were recorded.Results All patients were born after 28 until 32 weeks’ gestation. 36 patients were treated with oral ibuprofen and 32 with intravenous ibuprofen in this period. After the first course of the treatment, the PDA closed in 30 (83.3%) of the patients assigned to the oral ibuprofen group versus 23 (71.8%) of those enrolled in the intravenous ibuprofen group (p = 0.355). There was no difference between treatment groups in demographics or baseline renal function. In the evaluation of renal tolerance, none of the patients had oliguria. There were no significant differences with respect to complications during the stay.Conclusions In low birth weight infants, the rate of early ductal closure with oral ibuprofen is at least as good as with the intravenous route.  Oral ibuprofen is associated with fewer adverse effects

scholarly journals Influence of Family Integrated Care on the Intestinal Microbiome of Preterm Infants With Necrotizing Enterocolitis and Enterostomy: A Preliminary Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Mengyang Yang ◽  
Juan Du ◽  
Qin Yang ◽  
Wenyan Dou ◽  
Min Jiang ◽  
...  
Keyword(s):  
Integrated Care ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Intestinal Flora ◽  
Intestinal Microbiome ◽  
Rrna Gene ◽  
Α Diversity ◽  
Family Integrated Care ◽  
Family Integrated

The aim of this study was to investigate the influence of family integrated care (FICare) on the intestinal microbiome of preterm infants with necrotizing enterocolitis and enterostomy. This was a prospective pilot study at Beijing Children's Hospital. Premature infants with an enterostomy who met the enrollment criteria were divided into the 2-week FICare and non-FICare groups (non-randomly). We collected their fecal samples and subjected the intestinal microbiomes to 16S rRNA gene sequencing. Operational taxonomic units (OTU) were analyzed to assess the intestinal microbiome richness, and we then carried out α-diversity, β-diversity, and species clustering analyses and a linear discriminant analysis (LDA) effect size (LEfSe) analysis to identify the differences in the microbial communities between the two groups. There were 12 patients enrolled in the study (FICare, n = 7; non-FICare, n = 5). There were no significant between-group differences in demographic characteristics, or in the relative abundances of phyla and genera. The major bacterial phyla were Proteobacteria, Firmicutes, and Actinobacteria, and Serratia, Enterococcus, Cronobacter, and Bifidobacterium dominated at the genus level. The α-diversity analysis indicated that the intestinal flora was more diverse in the non-FICare group than the FICare group (p < 0.05). However, most of the other indicators did not suggest a difference between the two groups. There was a high proportion of shared OTUs between the two groups, and the PCoA and clustering analyses indicated that the two groups were difficult to distinguish, indicating that the intestinal microbiomes were relatively similar between the groups. In summary, short-term FICare had no significant positive effect on the establishment of intestinal flora diversity in premature infants with necrotizing enterocolitis and enterostomy. The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-OPN-17011801).

Feeding the feeble

2021 ◽  
pp. 265-272
Author(s):  
Michael Obladen
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Tube Feeding ◽  
Theoretical Knowledge ◽  
Air Inlet ◽  
Nasogastric Tubes ◽  
Nutritional Needs ◽  
The 1960S

This chapter describes historic steps in feeding techniques and knowledge about the nutritional needs of premature infants. Devices to overcome weak sucking and swallowing were developed from 1851 to 1920: tube feeding by gavage, medicine droppers and pipettes, feeding bottles with air inlet, and beaked spoons for nasal feeding. Indwelling nasogastric tubes were in use from 1951. For alleged safety concerns, postnatal feeding was postponed until a week of starvation was reached in the 1950s and studies showed an association with neurological handicaps. The premature infant’s elevated need for energy, protein, and minerals has been known since 1919. However, nutritional practice lagged behind theoretical knowledge. Concentrated formula was developed in the 1940s, parenteral supplementation in the 1960s, and human milk fortifiers in the 1970s. In the 1990s, necrotizing enterocolitis was found to be more frequent in infants fed formula than in those fed human milk. Recently, probiotics were shown to reduce the risk of necrotizing enterocolitis. Compared to other aspects of neonatal medicine, there is little evidence on how to feed preterm infants.

High Dose Indomethacin for Patent Ductus Arteriosus Closure Increases Neonatal Morbidity

2019 ◽  
Author(s):  
Salome Waldvogel ◽  
Andrew Atkinson ◽  
Mélanie Wilbeaux ◽  
Mathias Nelle ◽  
Markus R. Berger ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Standard Dose ◽  
Ductus Arteriosus ◽  
Treatment Options ◽  
Univariate Analysis ◽  
High Dose ◽  
Closure Rate ◽  
Patent Ductus

Abstract Objective Symptomatic patent ductus arteriosus (sPDA) is the most common heart abnormality in preterm infants. Optimal duration and dose of medical treatment is still unclear. We assessed undesired effects and closure rate of high-dose indomethacin (HDI) for pharmacological closure of sPDA. Study Design Retrospective single center analysis of 248 preterm infants born between January 2006 and December 2015 with a birth weight <2,000 g and sPDA which was treated with indomethacin. Patients were treated with either standard dose indomethacin (SDI; n = 196) or HDI (n = 52). Undesired effects and PDA closure were compared between patients treated with SDI and HDI. Results In univariate analysis, patients receiving HDI had a significant increase in gastrointestinal hemorrhage (32.7 vs.11.7%, p = 0.001), bronchopulmonary dysplasia (BPD) (77.8 vs. 55.1%, p = 0.003), and retinopathy of prematurity (13.5 vs. 2.6%, p = 0.004). Moreover, HDI patients needed longer mechanical ventilation (2.5 vs. 1.0 days, p = 0.01). Multivariate analyses indicated that necrotizing enterocolitis (17 vs. 7%, p = 0.01) and BPD (79 vs. 55%, p = 0.02) were more frequent in HDI patients. PDA closure rate was 79.0% with HDI versus 65.3% with SDI. Conclusion HDI used for PDA closure is associated with an increase in necrotizing enterocolitis and BPD. Risks of HDI should be balanced against other treatment options.

scholarly journals Conservative Non-intervention Approach for Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants

2020 ◽  
Vol 8 ◽  
Author(s):  
Se In Sung ◽  
Yun Sil Chang ◽  
So Yoon Ahn ◽  
Heui Seung Jo ◽  
Misun Yang ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Ductus Arteriosus ◽  
Intervention Approach ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Surgical Treatments ◽  
Minimal Evidence ◽  
Patent Ductus

While persistent patent ductus arteriosus (PDA) in preterm infants has been known to be associated with increased mortality and morbidities including bronchopulmonary dysplasia, and necrotizing enterocolitis, there is minimal evidence supporting their causal relationships, and most traditional medical and/or surgical treatments have failed to show improvements in these outcomes. As such, the pendulum has swung toward the conservative non-intervention approach for the management of persistent PDA during the last decade; however, the benefits and risks of this approach are unclear. In this mini review, we focused on whom, when, and how to apply the conservative non-intervention approach for persistent PDA, especially in extremely preterm infants.

scholarly journals Placental Vascular Obstructive Lesions: Risk Factor for Developing Necrotizing Enterocolitis

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Laure Dix ◽  
Matthias Roth-Kleiner ◽  
Maria-Chiara Osterheld
Keyword(s):  
Risk Factor ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Strong Association ◽  
Age Groups ◽  
Control Group ◽  
Age Group ◽  
Significant Difference ◽  
And Control

Necrotizing enterocolitis (NEC) is a severe neonatal disease affecting particularly preterm infants. Its exact pathogenesis still remains unknown. In this study, we have compared the prevalence of vascular obstructive lesions in placentae of premature newborns which developed NEC and of a control group. We further compared separately the findings of placentae of infants of less than 30 weeks of gestation, the age group in which NEC occurs most frequently. We found signs of fetal vascular obstructive lesions in 65% of the placentae of preterm patients developing NEC, compared to only 17% of the placentae of preterm patients in the control group. In the age groups below 30 weeks of gestation, 58.5% of placentae of later NEC patients presented such lesions compared to 24.5% in the control group. The significant difference between NEC and control group suggests a strong association between fetal vascular obstructive lesions and NEC. Therefore, we propose that fetal vascular obstructive lesions might be considered as a risk factor for the development of NEC in premature infants.

Perioperative Complications Following Surgery for Necrotizing Enterocolitis

2018 ◽  
Vol 28 (02) ◽  
pp. 148-151 ◽  
Author(s):  
Annika Mutanen ◽  
Agostino Pierro ◽  
Augusto Zani
Keyword(s):  
Surgical Treatment ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Perioperative Complications ◽  
Neurodevelopmental Outcome ◽  
Wound Infections ◽  
Perioperative Morbidity

AbstractNecrotizing enterocolitis (NEC) is a devastating condition that mainly affects premature infants. Advanced cases of NEC require surgical treatment, which in up to 70% of infants is associated with significant perioperative morbidity including anastomosis- or enterostomy-related complications, sepsis, peritonitis, and wound infections. Moreover, the perioperative complications may compromise the long-term gastrointestinal and neurodevelopmental outcome of patients requiring surgery for NEC.

scholarly journals Circulating Forms of B-Type Natriuretic Peptide in Very Preterm Infants

2020 ◽  
Vol 5 (3) ◽  
pp. 506-515
Author(s):  
Sarah L Harris ◽  
Richard Troughton ◽  
Lynley Lewis ◽  
Nicola Austin ◽  
Chris Pemberton
Keyword(s):  
Natriuretic Peptide ◽  
Preterm Infants ◽  
Premature Infants ◽  
High Performance ◽  
Ductus Arteriosus ◽  
Clinical Status ◽  
Volume Overload ◽  
Published Data ◽  
Very Preterm Infants ◽  
Group 2

Abstract Background B-type natriuretic peptide (BNP) is a cardiac hormone released with an N-terminal fragment (NTproBNP) under conditions of ventricular pressure or volume overload. BNP has been proposed for use as a biomarker of cardiac dysfunction in premature infants in the setting of hemodynamically significant patent ductus arteriosus (HsPDA) and bronchopulmonary dysplasia (BPD). In adult settings the presence of proBNP and glycosylated isoforms may affect assay interpretation. However, there are limited data on how immature preterm physiology may affect BNP or NTproBNP levels and no published data on post-translational BNP processing in premature infants. Methods Pooled serial plasma samples from preterm infants born at less than 30 weeks gestation were analyzed for BNP congeners using Luminex® assay and high performance liquid chromatography. Samples were grouped according to clinical status: Group 1, no HsPDA and no BPD, Group 2 HsPDA and no/mild BPD, Group 3 HsPDA and moderate/severe BPD. Results Plasma from 15 infants was analyzed, and across all three groups NTproBNP predominated with minimal amounts of other isoforms; no glycosylation was detected. Conclusions NTproBNP appears to be the predominant isoform across each of our clinical groups in our pooled sample analysis with no evidence of significant glycosylation. This suggests NTproBNP is likely to be a robust marker in this clinical setting.

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