Pathogenesis and Prevention of Necrotizing Enterocolitis: A Hypothesis Based on Personal Observation and a Review of the Literature

PEDIATRICS ◽  
1984 ◽  
Vol 74 (6) ◽  
pp. 1086-1092 ◽  
Author(s):  
Ann M. Kosloske
Keyword(s):  
High Risk ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Pathogenic Bacteria ◽  
Bacterial Colonization ◽  
Intestinal Flora ◽  
Intestinal Lumen ◽  
Term Infants ◽  
Intestinal Necrosis ◽  
High Risk Infants

The hypothesis is, that necrotizing enterocolitis (NEC) of the neonate occurs by the coincidence of two of three pathologic events: (1) intestinal ischemia, (2) colonization by pathogenic bacteria, and (3) excess protein substrate in the intestinal lumen. NEC is more likely to appear following quantitative extremes, ie, severe ischemia highly pathogenic flora, or marked excess of substrate. NEC develops only if a threshhold of injury, sufficient to initiate intestinal necrosis, is exceeded. The hypothesis is derived from previous theories by Santulli, which implicated all three events, and by Lawrence, in which a single event, abnormal bacterial colonization, was considered sufficient to induce NEC. This hypothesis may explain both typical occurrences of NEC among high-risk premature infants in neonatal intensive care units (NICUs), and atypical occurrences among infants considered at low-risk, eg, previously healthy term infants, infants fed breast milk exclusively, and infants never fed. It may further explain why NEC fails to develop in most high-risk infants in NICUs. Preventive measures might include: (1) pharmacologic stabilization of intestinal perfusion, (2) modification of the intestinal flora, or (3) feeding colostrum or other protective substances. Each theoretical benefit is accompanied by potential risks. The prevention of NEC may require favorable intervention in two of the three pathologic events.

119 Communicating Sensitive Information - An Exploration of Parental Perspectives on Prognostication of High Risk Infants

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e85-e85
Author(s):  
Emily Fong ◽  
Ronit Mesterman
Keyword(s):  
High Risk ◽  
Preterm Infants ◽  
Average Length ◽  
Sensitive Information ◽  
Neurocognitive Deficits ◽  
Biological Father ◽  
Perinatal Medicine ◽  
Term Infants ◽  
Neurologic Recovery ◽  
High Risk Infants

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Preterm infants are at high risk of experiencing a range of impairments that may contribute to long-term challenges such as neurocognitive deficits. Physicians are often expected to give an outlook on future developmental outcomes of high-risk infants, often before sufficient time has elapsed to observe whether that particular child will demonstrate neurologic recovery from the initial injury. Clinicians often struggle with communicating this information, especially a poor prognosis, because of the worry about how these conversations affect families and their future expectations of the child. Objectives Our aim was to capture parents' retrospective perceptions of how their infant’s prognosis was communicated to them during their NICU stay. Design/Methods Semi-structured interviews were conducted over the phone with parents of former preterm infants with a birthweight below 1500 grams or parents of term infants who have sustained HIE requiring cooling. Parents were invited to participate when their child was between 12-36 months old at the time of the interview, so that parents would be able to have a sense of their child’s development and possible impairments. The data was analyzed thematically, with particular focus around the discourse of communication and prognostication. Results Twenty-three interviews were conducted: 20 with the biological mother, two with both biological parents, and one with the biological father. The average length of the interviews was 30 minutes. The main themes that recurred in the interviews included parental loss of control, needing to prepare for the unexpected, the value of shared decision making between the health care practitioners and parents, recognition and conveyance of uncertainty by the physician, and the importance of celebrating the present. Above all, a recurring theme mentioned by the majority of interviewees was the power of hope. While wanting to receive transparent and honest updates, parents felt strongly that giving them realistic hope was of utmost importance. Conclusion Although clinicians often feel pressured to deliver answers, parents found it helpful when clinicians acknowledged and explained the uncertainty that surrounds prognostication. While healthcare providers may feel the need to prepare parents for the worst, the importance of balancing this information with hope and positivity is what families remember and value years after the prognosis was given.

“Womb” Literacy: Reading to Infants in the NICU

2004 ◽  
Vol 23 (4) ◽  
pp. 65-69 ◽  
Author(s):  
Martha Wilson Jones ◽  
Donna Englestad
Keyword(s):  
High School ◽  
Academic Achievement ◽  
High Risk ◽  
Preterm Infants ◽  
Cognitive Outcomes ◽  
Term Infants ◽  
Medical Needs ◽  
Iq Scores ◽  
Repeating A Grade ◽  
High Risk Infants

PROMOTING LITERACY IS NOT generally one of the top priorities in the care of high-risk infants in the NICU. Basic survival and tending to medical needs are obviously the most pressing concerns. However, we know from various studies that high-risk infants are at greater risk for less-than-optimal cognitive outcomes.1–3 For example, preterm infants are at greater risk than term infants for lower overall IQ scores, repeating a grade, and failing to graduate from high school.1,2 Interventions to improve the academic achievement of children are most effective when begun in the preschool years.4

scholarly journals Heme oxygenase-1 deficiency promotes the development of necrotizing enterocolitis-like intestinal injury in a newborn mouse model

2013 ◽  
Vol 304 (11) ◽  
pp. G991-G1001 ◽  
Author(s):  
Stephanie Schulz ◽  
Ronald J. Wong ◽  
Kyu Yun Jang ◽  
Flora Kalish ◽  
Karen M. Chisholm ◽  
...  
Keyword(s):  
Mouse Model ◽  
Necrotizing Enterocolitis ◽  
Heme Oxygenase ◽  
Bacterial Colonization ◽  
Intestinal Injury ◽  
Heme Oxygenase 1 ◽  
Newborn Mouse ◽  
Intestinal Necrosis ◽  
Matrix Metallopeptidase

Necrotizing enterocolitis (NEC) is typified by mucosal destruction, which subsequently can lead to intestinal necrosis. Prematurity, enteral feeding, and bacterial colonization are the main risk factors and, combined with other stressors, can cause increased intestinal permeability, injury, and an exaggerated inflammatory response. Heme oxygenase-1 (HO-1) mediates intestinal protection due to anti-inflammatory, antioxidative, and antiapoptotic effects of its products carbon monoxide, biliverdin, and bilirubin. This study investigates a possible role of HO-1 in the pathogenesis of NEC using a newborn mouse model. We induced NEC-like intestinal injury in 7-day-old HO-1 heterozygous (HO-1 Het, Hmox1+/-) and wild-type (Wt, Hmox1+/+) mice by gavage feeding and hypoxic exposures. Control (Con) pups of both genotypes were dam-fed. Intestines of HO-1 Het Con pups appeared predisposed to injury, with higher histological damage scores, more TUNEL-positive cells, and a significant reduction in muscularis externa thickness compared with Wt Con pups. The increase in HO activity after HO-1 induction by the substrate heme or by hypoxic stress was significantly impaired in HO-1 Het pups. After induction of intestinal injury, HO-1 Het pups displayed significantly higher NEC incidence (78 vs. 43%), mortality (83 vs. 54%), and median scores (2.5 vs. 1.5) than Wt NEC pups. PCR array analyses revealed increased expressions of IL-1β, P-selectin, matrix metallopeptidase 2, collagen type XVIII-α1, serpine 1, and others in NEC-induced HO-1 Het ileal and jejunal tissues. We conclude that a partial HO-1 deficiency promotes experimental NEC-like intestinal injury, possibly mediated by exaggerated inflammation and disruption in tissue repair.

scholarly journals Epidemiology ofStaphylococcus aureusin Neonates on Admission to a Chinese Neonatal Intensive Care Unit

2019 ◽  
Author(s):  
Wenjing Geng ◽  
Yujie Qi ◽  
Wenting Li ◽  
Thomas H. McConvillle ◽  
Alexandra Hill-Ricciuti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
High Risk ◽  
Molecular Epidemiology ◽  
Neonatal Intensive Care ◽  
Sccmec Type ◽  
Protein A ◽  
Staphylococcal Protein A ◽  
High Risk Infants ◽  
Culture Positive

ABSTRACTPurposeLittle is known about the molecular epidemiology ofStaphylococcus aureusin Chinese neonatal intensive care units (NICUs). We describe the molecular epidemiology ofS. aureusisolated from neonates on admission to Beijing Children’s Hospital.MethodsFrom May 2015-March 2016, nasal swabs were obtained on admission from 536 neonates. Cultures were also obtained from body sites with suspected infections.S. aureusisolates were characterized by staphylococcal chromosomal cassette (SCCmec) type, staphylococcal protein A (spa) type, multilocus sequence type (MLST),sasXgene, antimicrobial susceptibility and cytotoxicity. Logistic regression assessed risk factors for colonization.ResultsOverall, 92 (18%) infants were colonized withS. aureusand 23 (4%) were diagnosed with culture-positiveS. aureusinfection. Of the colonized infants, 72% harbored MSSA, while 74% of infected infants were culture-positive for MRSA. Risk factors for colonization included female sex, age 7-28 days, birthweight and vaginal delivery. The most common MRSA and MSSA clones were community-associated ST59-SCCmecIVa-t437 (60%) and ST188-t189 (15%), respectively. ThesasXgene was not detected. Some MSSA isolates (16%) were penicillin-susceptible and some MRSA isolates (18%) were oxacillin-susceptible. MRSA and MSSA had similar cytotoxicity, but colonizing strains were less cytotoxic than strains associated with infections.ConclusionsS. aureuscolonization was common in infants admitted to our NICU and two community-associated clones predominated. Several non-modifiable risk factors forS. aureuscolonization were identified. These results suggest that screening infants forS. aureusupon admission and targeting decolonization of high-risk infants and/or those colonized with high-risk clones could be useful to prevent transmission.

scholarly journals Auditory Screening Test of the High Risk Infants in the Neonatal Intensive Care Unit.

1998 ◽  
Vol 41 (3) ◽  
pp. 200-206 ◽  
Author(s):  
Fumiko Hata ◽  
Mariko Tanaka ◽  
Keisuke Kitaoku ◽  
Kazuhiko Nario ◽  
Takashi Matsunaga
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Neonatal Intensive Care Unit ◽  
Screening Test ◽  
Neonatal Intensive Care ◽  
High Risk Infants

ABR Screening of High-Risk Infants: Effects of Ambient Noise in the Neonatal Nursery

1986 ◽  
Vol 94 (5) ◽  
pp. 552-560
Author(s):  
Kenneth H. Richmond ◽  
Dan F. Konkle ◽  
William P. Potsic
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Background Noise ◽  
Neonatal Intensive Care ◽  
Ambient Noise ◽  
Quiet Condition ◽  
Screening Programs ◽  
High Risk Infants ◽  
Signal Intensities

This investigation examined ABR waveforms obtained at five signal intensities (20, 30, 40, 60, and 80 dB nHL) for adults and at three signal intensities (20, 40, and 80 dB nHL) for infants. ABR recordings were obtained in a quiet condition and repeated for three different intensity levels (40, 50, and 60 dBA) of background noise characteristic of a neonatal intensive care unit. The subjects were ten adults and ten infants whose ABRs were judged normal when measured at 20 dB nHL in the quiet condition. Results indicated that high levels of ambient noise (up to 60 dBA) did not influence either absolute wave V or interwave latencies measured for stimulus intensities of 60 and 80 dB nHL. ABR waveforms obtained at stimulus intensities often used for screening (i.e., 20, 30 or 40 dB nHL), however, were substantially altered for some subjects as a function of increasing levels of ambient noise. This observation was most apparent for the infant population and has important implications for the design of infant ABR screening programs.

Role of umbilical interleukin-6, procalcitonin and C-reactive protein measurement in the dia gnosis of fetal inflammatory response syndrome

2021 ◽  
Vol 86 (2) ◽  
pp. 80-85
Author(s):  
Zbyněk Straňák ◽  
◽  
Ivan Berka ◽  
Jan Širc ◽  
Jan Urbánek ◽  
...  
Keyword(s):  
High Risk ◽  
Inflammatory Response ◽  
Neonatal Mortality ◽  
Interleukin 6 ◽  
C Reactive Protein ◽  
Term Infants ◽  
Mortality And Morbidity ◽  
Reactive Protein ◽  
High Risk Infants ◽  
Fetal Inflammatory Response

Overview Objective: Fetal Inflammatory Response Syndrome (FIRS) is a serious complication accompanied by increased neonatal mortality and morbidity. Early dia­gnosis of FIRS is essential to detect high risk infants. The aim of the study was to evaluate the correlation between interleukin-6 
(IL-6), procalcitonin (PCT), C-reactive protein (CRP) in cord blood and histologically proven funisitis/ chorioamnionitis in high-risk infants after preterm birth. Methods: Blood sampling for the measurement of inflammatory bio­markers was performed immediately after placental delivery and umbilical cutting. Umbilical and placental inflammatory changes were assessed using a recently released scoring system (Amsterdam Placental Workshop Group Consensus). Results: One hundred preterm infants (30.5 ± 2.5 gestational week, birth weight 1,443 ± 566 grams) and 21 health term infants were analyzed. Histologic chorioamnionitis was confirmed in 19% cases and chorioamnionitis with funisitis in 7% cases. Thirty-three infants (33%) fulfilled criteria of FIRS (funistis and/ or umbilical IL-6 > 11 ng/ L). The presence of FIRS correlated significantly with maternal leukocytosis (P < 0.001), preterm premature rupture of membrane (P < 0.001) and preterm uterine contraction (P < 0.0001). In comparison to preterm and healthy term infants we found statistically significant higher levels of umbilical inflammatory bio­markers (IL-6, PCT, CRP) in FIRS group (P < 0.0001). Composite mortality and morbidity (bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leukomalacia) was higher in FIRS group (28.1 vs 22.4% in preterm group). However, the difference was not statistically significant (P = 0.53). Conclusion: Our study confirmed the correlation of umbilical inflammatory bio­markers levels (IL-6, PCT, CRP) and the presence of FIRS. We did not find significant adverse impact of FIRS on neonatal mortality and morbidity. Nevertheless, our results could be influenced by the size of study group and strict inclusion criteria (only cases after C-section were analyzed). Keywords: fetal inflammatory response syndrome – neonatal mortality – morbidity – interleukin-6 – C-reactive protein – procalcitonin – chorioamnionitis and funisitis

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