Predictive Indicators for Necrotizing Enterocolitis With the Presence of Portal Venous Gas and Outcomes of Surgical Interventions

Objectives: Portal venous gas (PVG) was an important clinical sign in stage II or III necrotizing enterocolitis (NEC) in preterm neonates. Not a proper predictive indicator was found to predict the diseases (NEC with the presence of PVG) up to now. There is a need to put forward predictive indicators and compare the predictive effects among them.Methods: We conducted a retrospective study of preterm neonates with NEC-PVG (n = 61) or NEC-non PVG (n = 62) from 2014 to 2021. Predictive indicators were put forward and determined by receiver operating characteristic curve analysis. An analysis of the surgical interventions and their outcomes was performed.Results: The incidence rate of NEC among preterm neonates was 4.99%; surgical and conservative interventions accounted for 20.47 and 75.07%, and the mortality rate was 0.03%. The composition ratio of shock in the NEC-PVG group increased 13.2% (P = 0.029). C-reactive protein, fibrinogen degradation product, and blood glucose had better predictive effects in the predictive indicators (P < 0.05). Intestinal necrosis and subependymal hemorrhage in the outcomes of surgical interventions had a strong relationship with the presence of PVG in NEC II/III (P < 0.05).Conclusion: Early and reasonable use of antibiotics, improvement of coagulation function, rectification of acidosis, and decreased blood glucose could cut down the occurrence of the disease (NEC with the presence of PVG). Except for subependymal hemorrhage and intestinal necrosis, NEC with the presence of PVG did not increase the occurrence of other outcomes after surgery.

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Association Between Platelet-to-Lymphocyte Ratio and Preterm Necrotizing Enterocolitis

Frontiers in Pediatrics ◽

10.3389/fped.2021.686880 ◽

2021 ◽

Vol 9 ◽

Author(s):

Juan Zheng ◽

Hua Wang

Keyword(s):

Necrotizing Enterocolitis ◽

Very Low Birth Weight ◽

University Hospital ◽

Preterm Neonates ◽

Control Group ◽

Platelet To Lymphocyte Ratio ◽

Retrospective Case ◽

Low Birth Weight Infants ◽

Intestinal Necrosis ◽

Lymphocyte Ratio

Introduction: Necrotizing enterocolitis (NEC) is a fatal condition for very-low-birth-weight infants. Necrotizing enterocolitis is a multi-factor phenomenon that results in intestinal mucosal damage and leads to intestinal necrosis. However, sensitive laboratory indicators for NEC are lacking, making early diagnosis difficult. This study aimed to explore the relationship between the platelet-to-lymphocyte ratio (PLR) and NEC in preterm neonates to enable an earlier diagnosis of the condition.Methods: This was a retrospective case–control study of preterm neonates diagnosed with NEC between January 2018 and December 2019 in the West China Second University Hospital. Controls were selected from preterm neonatal intensive care unit (NICU) graduates, and they were matched for gestation and year of birth to the preterms diagnosed without NEC. In total, 93 and 107 infants were included in the NEC and control groups, respectively. Empowerstats analysis was used to identify the association between PLR and preterm NEC.Results: The NEC group had significantly higher PLR levels than the control group. PLR > 100 within 1 week before NEC diagnosis was a risk factor for NEC. There was a positive connection between PLR and preterm NEC. A PLR of >100 was determined as the optimal cutoff for predicting preterm NEC, with patients with PLR >100 having a higher risk of NEC [odds ratio (OR): 18.82 (95% confidence interval (CI): 2.93–120.98), p = 0.002].Conclusions: A PLR of >100 within 1 week after clinical abnormalities is associated with a high risk of NEC in preterm neonates.

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Placental Transfusion, Timing of Plastic Wrap or Bag Placement, and Preterm Neonates

American Journal of Perinatology ◽

10.1055/s-0041-1730437 ◽

2021 ◽

Author(s):

William Engle ◽

Izlin Lien ◽

Brian Benneyworth ◽

Jennifer Stanton Tully ◽

Alana Barbato ◽

...

Keyword(s):

Necrotizing Enterocolitis ◽

Outcome Data ◽

Delivery Room ◽

Respiratory Support ◽

Preterm Neonates ◽

Quality Improvement Initiative ◽

Delayed Cord Clamping ◽

Cord Clamping ◽

Simultaneous Group ◽

Sequential Group

Objective Compare delivery room practices and outcomes of infants born at less than 32 weeks' gestation or less than 1,500 g who have plastic wrap/bag placement simultaneously during placental transfusion to those receiving plastic wrap/bag placement sequentially following placental transfusion. Study Design Retrospective analysis of data from a multisite quality improvement initiative to refine stabilization procedures pertaining to placental transfusion and thermoregulation using a plastic wrap/bag. Delivery room practices and outcome data in 590 total cases receiving placental transfusion were controlled for propensity score matching and hospital of birth. Results The simultaneous and sequential groups were similar in demographic and most outcome metrics. The simultaneous group had longer duration of delayed cord clamping compared with the sequential group (42.3 ± 14.8 vs. 34.1 ± 10.3 seconds, p < 0.001), and fewer number of times cord milking was performed (0.41 ± 1.26 vs. 0.86 ± 1.92 seconds, p < 0.001). The time to initiate respiratory support was also significantly shorter in the simultaneous group (97.2 ± 100.6 vs. 125.2 ± 177.6 seconds, p = 0.02). The combined outcome of death or necrotizing enterocolitis in the simultaneous group was more frequent than in the sequential group (15.3 vs. 9.3%, p = 0.038); all other outcomes measured were similar. Conclusion Timing of plastic wrap/bag placement during placental transfusion did affect duration of delayed cord clamping, number of times cord milking was performed, and time to initiate respiratory support in the delivery room but did not alter birth hospital outcomes or respiratory care practices other than the combined outcome of death or necrotizing enterocolitis. Key Points

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Case Report: Clostridium neonatale Bacteremia in a Preterm Neonate With Necrotizing Enterocolitis

Frontiers in Pediatrics ◽

10.3389/fped.2021.771467 ◽

2021 ◽

Vol 9 ◽

Author(s):

Nadim Cassir ◽

Isabelle Grandvuillemin ◽

Manon Boxberger ◽

Priscilla Jardot ◽

Farid Boubred ◽

...

Keyword(s):

Necrotizing Enterocolitis ◽

Potential Role ◽

Preterm Neonate ◽

Gastrointestinal Disorder ◽

Etiologic Agent ◽

Preterm Neonates ◽

Environmental Cleaning ◽

Life Threatening

Necrotizing enterocolitis is a life-threatening acquired gastrointestinal disorder among preterm neonates and is associated with a high mortality rate and long-term neurodevelopmental morbidity. No etiologic agent has been definitively established; nonetheless, the most implicated bacteria include members of the Clostridium genus. We reported here on a case of Clostridium neonatale bacteremia in a preterm neonate with necrotizing enterocolitis, providing more information regarding the potential role of this bacterium in pathogenesis of necrotizing enterocolitis. We emphasized the sporulating form of C. neonatale that confers resistance to disinfectants usually applied for the hospital environmental cleaning. Further works are needed to establish the causal relationship between the occurrence of NEC and the isolation of C. neonatale, with promising perspectives in terms of diagnostic and therapeutic management.

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ABM Clinical Protocol #1: Guidelines for Blood Glucose Monitoring and Treatment of Hypoglycemia in Term and Late-Preterm Neonates, Revised 2014

Breastfeeding ◽

10.1016/b978-0-323-68013-4.00038-9 ◽

2022 ◽

pp. 782-789

Author(s):

Nancy Wight ◽

Kathleen A. Marinelli

Keyword(s):

Blood Glucose ◽

Glucose Monitoring ◽

Late Preterm ◽

Blood Glucose Monitoring ◽

Preterm Neonates ◽

Clinical Protocol

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Decreased hazard of necrotizing enterocolitis in preterm neonates receiving red cell transfusions

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.3109/14767058.2015.1016422 ◽

2015 ◽

Vol 29 (5) ◽

pp. 737-744 ◽

Cited By ~ 11

Author(s):

Beena G. Sood ◽

Anupama Rambhatla ◽

Ronald Thomas ◽

Xinguang Chen

Keyword(s):

Necrotizing Enterocolitis ◽

Preterm Neonates ◽

Red Cell

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Recent Potential Noninvasive Biomarkers in Necrotizing Enterocolitis

Gastroenterology Research and Practice ◽

10.1155/2019/8413698 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Kewei Wang ◽

Guozhong Tao ◽

Zhen Sun ◽

Karl G. Sylvester

Keyword(s):

Necrotizing Enterocolitis ◽

Very Low Birth Weight ◽

Gastrointestinal Disease ◽

Unmet Need ◽

Preterm Neonates ◽

Diagnostic Biomarkers ◽

The Past ◽

Clinical Associations ◽

Noninvasive Biomarkers ◽

Urine And Serum

Necrotizing enterocolitis (NEC) is a rare but devastating gastrointestinal disease that predominately affects preterm neonates. Numerous studies have revealed that NEC is strongly associated with very low birth weight, degree of prematurity, formula feeding, infection, hypoxic/ischemic injury, and enteric dysbiosis. Given these clinical associations, the search for a deeper understanding of disease pathogenesis has led to an intense interest in the discovery and development of noninvasive biomarkers of NEC from stool, urine, and serum. Biomarkers for NEC may serve at least two general purposes of urgent unmet need: to improve diagnostic accuracy and disease prediction and to reveal the mechanism of the disease. This review will provide an overview of recent research focused on clinical NEC and highlight the advances that were made within the past five years towards the development of noninvasive diagnostic biomarkers.

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Predicting developmental outcomes in preterm infants

Neurology ◽

10.1212/wnl.0000000000008172 ◽

2019 ◽

Vol 93 (13) ◽

pp. e1231-e1240 ◽

Cited By ~ 4

Author(s):

Dalit Cayam-Rand ◽

Ting Guo ◽

Ruth E. Grunau ◽

Isabel Benavente-Fernández ◽

Anne Synnes ◽

...

Keyword(s):

Characteristic Curve ◽

Brain Mri ◽

Adverse Outcomes ◽

Preschool Age ◽

Cognitive Outcomes ◽

White Matter Injury ◽

Preterm Neonates ◽

Posterior Commissure ◽

Neurodevelopmental Outcomes ◽

Motor Outcomes

ObjectiveTo develop a simple imaging rule to predict neurodevelopmental outcomes at 4.5 years in a cohort of preterm neonates with white matter injury (WMI) based on lesion location and examine whether clinical variables enhance prediction.MethodsSixty-eight preterm neonates born 24–32 weeks' gestation (median 27.7 weeks) were diagnosed with WMI on early brain MRI scans (median 32.3 weeks). 3D T1-weighted images of 60 neonates with 4.5-year outcomes were reformatted and aligned to the posterior commissure–eye plane and WMI was classified by location: anterior or posterior-only to the midventricle line on the reformatted axial plane. Adverse outcomes at 4.5 years were defined as Wechsler Preschool and Primary Scale of Intelligence full-scale IQ <85, cerebral palsy, or Movement Assessment Battery for Children, second edition percentile <5. The prediction of adverse outcome by WMI location, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP) was assessed using multivariable logistic regression.ResultsSix children had adverse cognitive outcomes and 17 had adverse motor outcomes. WMI location predicted cognitive outcomes in 90% (area under receiver operating characteristic curve [AUC] 0.80) and motor outcomes in 85% (AUC 0.75). Adding IVH, BPD, and ROP to the model enhances the predictive strength for cognitive and motor outcomes (AUC 0.83 and 0.88, respectively). Rule performance was confirmed in an independent cohort of children with WMI.ConclusionsWMI on early MRI can be classified by location to predict preschool age outcomes in children born preterm. The predictive value of this WMI classification is enhanced by considering clinical factors apparent by term-equivalent age.

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