Reduction in necrotizing enterocolitis and improved outcomes in preterm infants following routine supplementation with Lactobacillus GG in combination with bovine lactoferrin

Abstract Decades of research have failed to define the pathophysiology of necrotizing enterocolitis (NEC), a devastating pediatric gastrointestinal disorder of preterm infants. However, recent evidence suggests that host-microbiota interactions, in which microbial dysbiosis is followed by loss of barrier integrity, inflammation, and necrosis, are central to NEC development. Thus, greater knowledge of the preterm infant microbiome could accelerate attempts to diagnose, treat, and prevent NEC. Here, we summarize clinical characteristics of and risk factors for NEC, the structure of the pre-event NEC microbiome, how this community interfaces with host immunology, and microbiome-based approaches that might prevent or lessen the severity of NEC in this very vulnerable population.

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The Risk of Necrotizing Enterocolitis following the Administration of Hyperosmolar Enteral Medications to Extremely Preterm Infants

Neonatology ◽

10.1159/000513169 ◽

2021 ◽

pp. 1-7

Author(s):

Faiza Latheef ◽

Hanna Wahlgren ◽

Helene Engstrand Lilja ◽

Barbro Diderholm ◽

Mattias Paulsson

Keyword(s):

Clinical Practice ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Neonatal Intensive Care ◽

Significant Risk ◽

Quality Register ◽

Increased Risk ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Hyperosmolar Solutions

Introduction: Necrotizing enterocolitis (NEC) is a disease predominantly affecting preterm infants. The administration of hyperosmolar solutions could lead to the development of NEC. The objective of this study was to measure the osmolality of enteral medications used in clinical practice and to assess the risk of NEC following exposure to hyperosmolar medications. Methods: A retrospective cohort study in extremely preterm infants (gestational age <28 weeks) born between 2010 and 2016 at a tertiary neonatal intensive care unit in Sweden. 465 infants were identified via the Swedish Neonatal Quality register. Data relating to enteral administrations received during a two-week period were collected from the medical records. The osmolalities of medications were measured using an osmometer. Logistic regression was used to calculate the odds ratio of developing NEC. Results: A total of 253 patients met the inclusion criteria. The osmolalities of 5 commonly used medications significantly exceeded the recommended limit of 450 mOsm/kg set by the American Academy of Paediatrics (AAP). Most patients (94%) received at least one hyperosmolar medication. No significant risk of developing NEC could be found. Conclusion: The medications used in clinical practice can significantly exceed the limit set by the AAP. This study does not indicate an increased risk of developing NEC in extremely preterm infants following exposure to hyperosmolar medications. Further studies in larger cohorts are needed to determine the specific cut-off level of osmolality in relation to the pathogenesis of NEC.

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Cytokine therapy in necrotizing enterocolitis: A promising treatment for preterm infants

Cell Reports Medicine ◽

10.1016/j.xcrm.2021.100324 ◽

2021 ◽

Vol 2 (6) ◽

pp. 100324

Author(s):

Bingjie Wang ◽

Meghan A. Koch

Keyword(s):

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Cytokine Therapy ◽

Promising Treatment

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Stoma Closure Improves Head Circumference Growth in Very Preterm Infants after Necrotizing Enterocolitis

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1718407 ◽

2020 ◽

Author(s):

Karina Dyrvig Honoré ◽

Malene Nygaard Johansen ◽

Lars Rasmussen ◽

Gitte Zachariassen

Keyword(s):

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Head Circumference ◽

International Classification Of Diseases ◽

University Hospital ◽

Stoma Closure ◽

Poor Growth ◽

Very Preterm Infants ◽

Very Preterm ◽

Stoma Formation

Abstract Introduction Very preterm infants (VPIs) surgically treated for necrotizing enterocolitis (NEC) are at risk of growth retardation. The aim of this study was to demonstrate and compare growth during the first 6 years of life in VPIs with stoma after NEC surgery with VPIs without NEC surgery. Materials and Methods We included all VPIs surgically treated due to NEC at the Odense University Hospital from August 1, 2004, to July 31, 2008. Outcome on growth was compared with a group of VPIs without NEC. The VPIs with NEC were identified searching the local database using the International Classification of Diseases, 10th Revision diagnosis of NEC (DP77.9). Data on growth were collected from medical files and if not present, the parents reported the data. Results Nineteen VPIs, surgically treated due to NEC, survived to 6 years of age. Median gestational age was 283/7 weeks (245/7–313/7). Median age at NEC surgery and stoma formation was 2.3 weeks (0.1–6.3) and median age at stoma closure was 2.5 months corrected age (CA) (postmenstrual age 36 weeks to CA 6.7 months). Compared with the non-NEC group, VPIs with NEC and stoma demonstrated poor growth, especially in head circumference (HC) with no increase in growth velocity before the time of stoma closure between 2.5- and 3-month CAs. Conclusion Our findings demonstrate poor growth in VPIs after NEC surgery and improved HC growth after stoma closure.

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ELFIN, the United Kingdom preterm lactoferrin trial: interpretation and future questions

Biochemistry and Cell Biology ◽

10.1139/bcb-2020-0073 ◽

2020 ◽

Author(s):

Janet Elizabeth Berrington ◽

William McGuire ◽

NIcholas David Embleton

Keyword(s):

United Kingdom ◽

Preterm Infants ◽

Late Onset ◽

Disease Onset ◽

Intervention Group ◽

Control Group ◽

Bovine Lactoferrin ◽

The United Kingdom ◽

Late Onset Sepsis ◽

The Uk

Previous studies suggested that supplemental bovine lactoferrin (BLF) given to preterm infants (<32 weeks gestation) may reduce late onset sepsis (LOS) and necrotising enterocolitis (NEC), but have been underpowered. The Enteral Lactoferrin in Neonates (ELFIN) study, performed in the United Kingdom (UK), aimed to further address this issue with a well powered double blinded placebo controlled trial of >2200 preterm infants. ELFIN did not demonstrate a reduction in LOS or NEC, or several other clinically important measures. 316 (29%) of 1093 infants in the intervention group developed late-onset sepsis versus 334 (31%) of 1089 in the control group with an adjusted risk ratio of 0·95 (95% CI 0·86–1·04; p=0· 233). Reasons for the differences in ELFIN trial results and other studies may include population differences, the routine use of antifungals in the UK, timing of administration of the lactoferrin in relation to disease onset, or specific properties of the lactoferrin used in different trials. Further exploration is being undertaken in the UK NIHR funded Mechanisms Affecting the Guts of Preterm Infants in Enteral feeding trials (MAGPIE) study, for which results should be available soon.

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