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Peng C, Huang G, Chen X, Xie Z, Ali S, Chen X, Nie H, Yang Z, Zhu L, Chen X, Yan S. Identification of near-infrared characteristic bands of small bowel necrosis based on cellwise detection algorithm. JOURNAL OF BIOPHOTONICS 2024; 17:e202300438. [PMID: 38468556 DOI: 10.1002/jbio.202300438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/10/2024] [Accepted: 01/30/2024] [Indexed: 03/13/2024]
Abstract
The near-infrared spectroscopy is often used to distinguish small bowel necrosis due to necrotizing enterocolitis (NEC). The characteristic bands of small bowel necrosis, as an important basis for evaluating the confidence of the differentiation results, are challenging to identify quickly. In this study, we proposed to identify characteristic bands of lesion samples based on hyperspectral imaging (HSI) and cellwise outlier detection. Rabbits were used as an animal model to simulate the clinical symptoms of NEC. The rabbits were detected at intervals of 10, 30, 60, and 90 min. The characteristic bands were identified within the same rabbit, between different rabbits and at different times. The result showed the bands near 763 nm, corresponding to the absorption peak of deoxyhemoglobin, were the characteristic bands separating samples with NEC. The identification result was plausible because hypoxia was the main cause of NEC. The method was easy to perform.
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Affiliation(s)
- Chenxi Peng
- College of Life and Environmental Sciences, Wenzhou University, Wenzhou, China
| | - Guangzao Huang
- College of Electrical and Electronic Engineering, Wenzhou University, Wenzhou, China
| | - Xiaojing Chen
- College of Electrical and Electronic Engineering, Wenzhou University, Wenzhou, China
| | - Zhonghao Xie
- College of Electrical and Electronic Engineering, Wenzhou University, Wenzhou, China
| | - Shujat Ali
- College of Electrical and Electronic Engineering, Wenzhou University, Wenzhou, China
| | - Xi Chen
- College of Electrical and Electronic Engineering, Wenzhou University, Wenzhou, China
| | - Huagui Nie
- College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou, China
| | - Zhi Yang
- College of Chemistry and Materials Engineering, Wenzhou University, Wenzhou, China
| | - Libin Zhu
- Pediatric General Surgery, The Second Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoqing Chen
- Pediatric General Surgery, The Second Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shubin Yan
- School of Electrical Engineering, Zhejiang University of Water Resources and Electric Power, Hangzhou, China
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Gitau K, Ochieng R, Limbe M, Kathomi C, Orwa J. The incidence and modifiable risk factors for necrotizing enterocolitis in preterm infants: a retrospective cohort study. J Matern Fetal Neonatal Med 2023; 36:2253351. [PMID: 37648650 DOI: 10.1080/14767058.2023.2253351] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES To evaluate the incidence and modifiable risk factors for Necrotizing enterocolitis (NEC) in preterm infants born at ≤32 weeks of gestation weighing <1500 grams, at a private tertiary care hospital in Kenya. MATERIALS AND METHODS This retrospective cohort study was conducted at the Aga Khan University Hospital Neonatal Intensive Care Unit (NICU). Preterm infants born at ≤ 32 weeks' gestation and weighing <1500 grams admitted to NICU between 2009 and 2019, were recruited into the study. The primary outcome was NEC Bell Stage IIa-IIIb based on Modified Bell's criteria. Maternal and neonatal characteristics were evaluated. The association between variables of interest and NEC was determined using logistic regression analysis and the incidence of NEC for the study period was calculated. RESULTS A total of 261 charts of infants born at ≤ 32 weeks' gestation, weighing <1500 were reviewed, and 200 charts met the inclusion criteria. Fifteen preterm infants developed the primary outcome of interest: NEC Stage ≥2a within the first 30 days of admission. The overall incidence of NEC for the study period was 7.5%. Three risk factors were identified as significantly associated with NEC on multivariate logistic regression analysis: antenatal exposure to steroids (OR = 0.056 CI = 0.003-0.964 p = 0.047), cumulative duration of exposure to invasive mechanical ventilation (OR = 2.172 CI = 1.242-3.799 p = 0.007) and cumulative duration of exposure to umbilical vein catheter (OR = 1.344 CI = 1.08-1.672 p = 0.008). CONCLUSIONS The overall incidence for the study period of NEC Stage ≥ II a was 7.5%. Exposure to antenatal steroids, duration of mechanical ventilation, and duration of umbilical vein catheterization were three independent modifiable risk factors for NEC Stage II a-Stage III b.
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Affiliation(s)
- Kelvin Gitau
- Department of Paediatrics and Child Health, Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - Roseline Ochieng
- Department of Paediatrics and Child Health, Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - Mary Limbe
- Department of Paediatrics and Child Health, Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | | | - James Orwa
- Department of Population Health, Aga Khan University Hospital Nairobi, Nairobi, Kenya
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张 婷, 冯 艺, 胡 勇, 应 俊, 王 少, 王 华. [Association Between Different Modes of Respiratory Support and Feeding Intolerance in Preterm Infants: A Retrospective Cohort Study]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:1239-1244. [PMID: 38162081 PMCID: PMC10752787 DOI: 10.12182/20231160104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 01/03/2024]
Abstract
Objective To explore the relationship between different modes of respiratory support and feeding intolerance (FI) in preterm infants over the course of their hospitalization and to provide recommendations for the management of enteral feeding in preterm infants requiring respiratory support. Methods A retrospective analysis was performed with the preterm infants admitted to the Neonatal Intensive Care Unit (NICU), West China Second University Hospital, Sichuan University between June 2015 and November 2018. The modes of respiratory support were used as independent variables and FI was used as the outcome indicator. The preterm infants were grouped according to the specific modes of respiratory support they were on over the course of their hospitalization and the relationship between each mode of respiratory support and FI was compared. Results A total of 272 preterm infants were enrolled in the study. After adjusting for confounding factors, findings from logistics regression suggested that, compared with normobaric oxygen, high flow nasal cannula (HFNC) might reduce the incidence of FI (odds ratio [OR]=0.53, 95% confidence interval [CI]: 0.06-4.77), while other modes of respiratory support might increase the incidence of FI. Compared with nasal continuous positive airway pressure (NCPAP), bilevel positive airway pressure (BIPAP) and invasive ventilation might increase the incidence of FI, with the adjusted OR being 1.31 and 1.69, and 95% CI being 0.67-2.55 and 0.65-4.41, respectively. The incidence of FI in BIPAP and invasive ventilation was similar (adjusted OR=1.00, 95% CI: 0.41-2.42). However, the P-values of the above results were all greater than 0.05. Conclusion HFNC has the lowest incidence of FI in the respiratory support modes examined in this study. Attention should be paid to enteral feeding management when using NCPAP, BIPAP, and invasive ventilation to avoid the occurrence of FI. Given the limited sample size, further research is warranted to confirm the conclusion.
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Affiliation(s)
- 婷 张
- 四川大学华西第二医院 新生儿科 (成都 610041)Neonatal Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- 出生缺陷与相关妇儿疾病教育部重点实验室(四川大学) (成都 610041)Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu 610041, China
| | - 艺 冯
- 四川大学华西第二医院 新生儿科 (成都 610041)Neonatal Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- 出生缺陷与相关妇儿疾病教育部重点实验室(四川大学) (成都 610041)Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu 610041, China
| | - 勇 胡
- 四川大学华西第二医院 新生儿科 (成都 610041)Neonatal Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- 出生缺陷与相关妇儿疾病教育部重点实验室(四川大学) (成都 610041)Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu 610041, China
| | - 俊杰 应
- 四川大学华西第二医院 新生儿科 (成都 610041)Neonatal Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- 出生缺陷与相关妇儿疾病教育部重点实验室(四川大学) (成都 610041)Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu 610041, China
| | - 少璞 王
- 四川大学华西第二医院 新生儿科 (成都 610041)Neonatal Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- 出生缺陷与相关妇儿疾病教育部重点实验室(四川大学) (成都 610041)Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu 610041, China
| | - 华 王
- 四川大学华西第二医院 新生儿科 (成都 610041)Neonatal Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- 出生缺陷与相关妇儿疾病教育部重点实验室(四川大学) (成都 610041)Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu 610041, China
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Corebima BI, Rohsiswatmo R, Santosaningsih D, Barlianto W, Handono K. Novel scoring system for early diagnosis of necrotizing enterocolitis: integrating clinical and laboratory data with urinary caveolin-1 levels. Arch Med Sci 2023; 20:444-456. [PMID: 38757010 PMCID: PMC11094821 DOI: 10.5114/aoms/173390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/05/2023] [Indexed: 05/18/2024] Open
Abstract
Introduction Necrotizing enterocolitis (NEC) poses a significant threat to preterm infants, with nonspecific early manifestations complicating timely diagnosis. Therefore, this study aimed to develop a novel scoring system for early diagnosis of NEC, incorporating clinical and laboratory data with urinary caveolin-1 levels. Material and methods A single-center prospective cohort study was conducted at a tertiary hospital in East Java, Indonesia. NEC diagnosis was established by Bell's criteria and proven gut dysbiosis. Urinary levels of claudin-2, caveolin-1, and epidermal growth factor (EGF) were assessed as potential indicators of tight junction disruption. The selected urine biomarker cutoff value was determined using symbolic classification analysis and combined with clinical and laboratory parameters from Bell's criteria to create an NEC scoring system, validated with the Aiken index. Sensitivity and specificity analyses were performed. Results Thirty-four neonates, comprising NEC, preterm non-NEC, and term infants, were included. qPCR analysis highlighted elevated Klebsiella, Lactobacillus, Clostridium, and Bacteroides levels in NEC patients, indicating a gut dysbiosis trend. Among 3 biomarkers, caveolin-1 ≥ 17.81 ng/dl on day 3 demonstrated 72.86% negative predictive value and 87.50% positive predictive value. The combined scoring system which comprised abdominal cellulitis, distension, radiology, advanced resuscitation at birth, prematurity or low birthweight, platelet count, sepsis, orogastric retention, metabolic acidosis and caveolin-1 findings exhibited an AUC of 0.922 (95% CI: 0.81-1.00, p < 0.001), with ≥ 1.81 as the cutoff, offering 93% sensitivity and 94% specificity. Conclusions Urine caveolin-1 on day 3 signifies enterocyte tight junction damage and the acute phase of NEC in premature infants. The proposed scoring system demonstrates good performance in predicting NEC incidence in preterm infants.
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Affiliation(s)
- Brigitta I.R.V. Corebima
- Doctoral Program in Medical Science, Faculty of Medicine, Brawijaya University, Indonesia
- Department of Pediatrics, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Indonesia
| | - Rinawati Rohsiswatmo
- Department of Pediatrics, Faculty of Medicine, University of Indonesia/Dr. Cipto Mangunkusumo General Hospital, Indonesia
| | - Dewi Santosaningsih
- Department of Clinical Microbiology, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Indonesia
| | - Wisnu Barlianto
- Department of Pediatrics, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Indonesia
| | - Kusworini Handono
- Department of Clinical Pathology, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Indonesia
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Song S, Zhang J, Zhao Y, Dai L. Development and Validation of a Nomogram for Predicting the Risk of Bell's Stage II/III Necrotizing Enterocolitis in Neonates Compared to Bell's Stage I. Front Pediatr 2022; 10:863719. [PMID: 35774099 PMCID: PMC9237363 DOI: 10.3389/fped.2022.863719] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with Bell's Stage II/III necrotizing enterocolitis (NEC) may have more severe presentations, higher rates of death, and more long-term complications than those with Bell's Stage I NEC, so the purpose of this article was to construct a nomogram model to distinguish Bell's stage II/III NEC early from Bell's Stage I NEC, which is critical in the clinical management of NEC. PATIENTS AND METHODS A total of 730 NEC newborns diagnosed from January 2015 to January 2021 were retrospectively studied. They were randomly divided into training and validation groups at the ratio of 7:3. A nomogram model for predicting NEC was developed based on all the independent risk factors by multivariate regression analysis. The model's performance was mainly evaluated through three aspects: the area under the curve (AUC) to verify discrimination, the Hosmer-Lemeshow test and calibration curve to validate the consistency, and decision curve analysis (DCA) to determine the clinical effectiveness. RESULTS Predictors included in the prediction model were gestational age (GA), birth weight (BW), asphyxia, septicemia, hypoglycemia, and patent ductus arteriosus (PDA). This nomogram model containing the above-mentioned six risk factors had good discrimination ability in both groups, and the AUCs were 0.853 (95% CI, 0.82-0.89) and 0.846 (95% CI, 0.79-0.90), respectively. The calibration curve and DCA confirmed that the nomogram had good consistency and clinical usefulness. CONCLUSIONS This individual prediction nomogram based on GA, BW, asphyxia, septicemia, hypoglycemia, and PDA served as a useful tool to risk-stratify patients with NEC, and can help neonatologists early distinguish Bell's stage II/III NEC early from Bell's Stage I NEC.
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Affiliation(s)
- Shuting Song
- Department of Neonatology, Anhui Provincial Children's Hospital, Anhui Medical University, Hefei, China
| | - Jian Zhang
- Department of Neonatology, Anhui Provincial Children's Hospital, Anhui Medical University, Hefei, China
| | - Yuwei Zhao
- Department of Neonatology, Anhui Provincial Children's Hospital, Anhui Medical University, Hefei, China
| | - Liying Dai
- Department of Neonatology, Anhui Provincial Children's Hospital, Anhui Medical University, Hefei, China
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Shaaban AIE, Alfqy OAE, Shaaban HMK, A-Maqsoud YH, Assar EH. Potential Role of Serum Intestinal Fatty Acid-Binding Protein as a Marker for Early Prediction and Diagnosis of Necrotizing Enterocolitis in Preterm Neonates. J Indian Assoc Pediatr Surg 2021; 26:393-400. [PMID: 34912135 PMCID: PMC8637987 DOI: 10.4103/jiaps.jiaps_218_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/05/2020] [Accepted: 12/15/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction: Intestinal fatty acid-binding protein (I-FABP) is located in the apex of mature enterocytes and released into circulation; once the injury of enterocyte happens, its circulating levels are considered an early and sensitive marker of intestinal ischemia as in necrotizing enterocolitis (NEC); because of its small molecular weight, it can be detected in urine. Aims: The aim was to study the usefulness of both serum and urine I-FABP in early diagnosis of NEC and to correlate the serum and urinary levels. Settings and Design: This study was case–control design. Methods: Simultaneous serum and urine samples obtained at the onset of symptoms, in 40 preterms with suspected NEC, with gestational age ± 27.70 weeks and birth weight ± 1.11 kg, i.e., 20 preterms diagnosed at Stage I, 12 preterms at Stage II, and 8 preterms at Stage III, were compared with age- and weight-matched preterms with no NEC. Statistical Analysis: The collected data were tabulated, coded, and then analyzed using the computer program Statistical Package for the Social Science (SPSS version 22). Results: Serum levels of I-FABP in NEC cases were significantly higher than the control group, with a mean of 6005.77 ± 6384.77 and 1480.79 ± 1276.48 pg/ml, respectively (P < 0.001). Urine levels of I-FABP in NEC cases were significantly higher than the control group, with a mean of 5009.22 ± 3941.64 and 2677.62 ± 2257.29 pg/ml, respectively (P = 0.04). Both serum and urine I-FABP levels not only in Stage II are significantly higher than Stage I but also in Stage III are significantly higher than Stage I and II (P < 0.001, P = 0.03, respectively), which showed significant positive correlation with stages of NEC (r = 0.618; P < 0.001; r = 0.306; P = 0.049, respectively). Both serum and urine I-FABP levels had a highly significant positive correlation with each other (r = 0.406 P < 0.0001). Receiving operating characteristic curve showed an area under the curve of 0.92 and 0.81 for serum and urine I-FABP, respectively. Conclusions: Whether serum or urinary I-FABP is valuable in the diagnosis and prediction of NEC and strongly correlated with the disease severity and with each other.
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Affiliation(s)
- Amin I E Shaaban
- Department of Paediatrics, Faculty of Medicine, Benha University, Benha, Egypt
| | - Osama A E Alfqy
- Department of Paediatrics, Faculty of Medicine, Benha University, Benha, Egypt
| | - Howayda M K Shaaban
- Department of Clinical Pathology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Yahya H A-Maqsoud
- Department of Paediatrics, Faculty of Medicine, Benha University, Benha, Egypt
| | - Effat H Assar
- Department of Paediatrics, Faculty of Medicine, Benha University, Benha, Egypt
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Wang ZL, An Y, He Y, Hu XY, Guo L, Li QY, Liu L, Li LQ. Risk factors of necrotizing enterocolitis in neonates with sepsis: A retrospective case-control study. Int J Immunopathol Pharmacol 2021; 34:2058738420963818. [PMID: 33016797 PMCID: PMC7543139 DOI: 10.1177/2058738420963818] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Sepsis, a severe infectious disease in the neonatal period, is considered a risk factor for necrotizing enterocolitis (NEC). To investigate the specific risk factors for NEC in septic infants, septic infants admitted to our center from January 2010 to April 2018 were included. Septic neonates with proven NEC (Bell's stage ⩾II) were enrolled in the NEC group, and those without NEC were enrolled in the control group. Demographics, clinical characteristics, and risk factors were compared between the two groups. Univariate and logistic regression analyses were used to evaluate the potential risk factors for NEC. A total of 610 septic neonates were included, of whom 78 (12.8%) had complicated NEC. The univariate analysis indicated that infants with NEC had a lower birth weight, a lower gestational age, and older age on admission than those without NEC (P < 0.05). Higher rates of anemia, prolonged rupture of membranes (PROM) (⩾18 h), pregnancy-induced hypertension, late-onset sepsis (LOS), red blood cell transfusion and hypoalbuminemia were observed in the NEC group than in the non-NEC group (P<0.05). Logistic regression analysis revealed LOS (P = 0.000), red blood cell transfusion (P = 0.001) and hypoalbuminemia (P = 0.001) were associated with the development of NEC. Among NEC infants, those who needed red blood cell transfusion had a longer hospitalization duration than those who did not need transfusion (P < 0.05). LOS, red blood cell transfusion and hypoalbuminemia were independent risk factors for the development of NEC in infants with sepsis. Taking measures to reduce the occurrence of hypoproteinemia and severe anemia may help to reduce the occurrence of NEC in septic neonates.
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Affiliation(s)
- Zheng-Li Wang
- Neonatal Diagnosis and Treatment Center, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Yao An
- Neonatal Diagnosis and Treatment Center, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Yu He
- Neonatal Diagnosis and Treatment Center, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Xiao-Yu Hu
- Neonatal Diagnosis and Treatment Center, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Lu Guo
- Neonatal Diagnosis and Treatment Center, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Qiu-Yu Li
- Neonatal Diagnosis and Treatment Center, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Li Liu
- Neonatal Diagnosis and Treatment Center, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
| | - Lu-Quan Li
- Neonatal Diagnosis and Treatment Center, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, P.R. China
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She X, Du H, Yi C, He Y, Ai Q, Yu J. The decrease of fucosylation in intestinal epithelium is related to the development of necrotizing enterocolitis. Mol Immunol 2021; 131:23-32. [PMID: 33465592 DOI: 10.1016/j.molimm.2020.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/06/2020] [Accepted: 12/30/2020] [Indexed: 02/07/2023]
Abstract
Necrotizing enterocolitis (NEC) is a devastating neonatal gastrointestinal emergency. Fucosylated glycans on intestinal epithelial cells (IECs) play a central role in the maintenance of intestinal homeostasis. Nevertheless, its association with necrotizing enterocolitis is not clear. We examined paraffin-embedded intestinal specimens from participants and found that the NEC patients showed lower intestinal epithelial fucosylation levels than the control patients. In the mouse model of NEC, the percentage of fucosylated epithelial cells (F-ECs) and ILC3s was decreased. Also, the expression levels of IL-22 and Fut2 were reduced. Moreover, the critical role of epithelial fucosylation in NEC was further confirmed by administering the anti-IL-22 antibody, which caused an increase in histological damage, body weight loss, intestinal permeability and proinflammatory cytokine release correlated with a reduction of F-ECs. Overall, intestinal fucosylation deficiency led to increased susceptibility and severity of NEC. Further studies are needed to determine whether modification of intestinal fucosylation affects the development of NEC.
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Affiliation(s)
- Xiang She
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; National Clinical Research Center for Child Health and Disorder, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Hua Du
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; National Clinical Research Center for Child Health and Disorder, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Cong Yi
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; National Clinical Research Center for Child Health and Disorder, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Yu He
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; National Clinical Research Center for Child Health and Disorder, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Qing Ai
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; National Clinical Research Center for Child Health and Disorder, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
| | - Jialin Yu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China; Department of Pediatrics, Shenzhen University General Hospital, Shenzhen, Guangdong, China; Chongqing Key Laboratory of Pediatrics, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; National Clinical Research Center for Child Health and Disorder, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.
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Cai N, Fan W, Tao M, Liao W. A significant decrease in hemoglobin concentrations may predict occurrence of necrotizing enterocolitis in preterm infants with late-onset sepsis. J Int Med Res 2020; 48:300060520952275. [PMID: 32962507 PMCID: PMC7518009 DOI: 10.1177/0300060520952275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 07/31/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to examine the clinical value of a decrease in hemoglobin concentration (HC) after the onset of sepsis for predicting occurrence of necrotizing enterocolitis (NEC) in preterm infants with late-onset sepsis. METHODS We performed a retrospective cohort study between January 2015 and January 2020. Premature neonates (gestational age <37 weeks) with late-onset sepsis (age >3 days) were enrolled. According to the degree of reduction in HC, neonates were divided into the non-decrease group, mild decrease group, and severe decrease group. Demographic data, perinatal conditions, blood cell count analysis, blood culture, and treatment measures were compared. RESULTS Eighty premature infants with sepsis were studied. The mortality rate and incidence of NEC were significantly higher in the severe decrease group than in the non-decrease and mild decrease groups. Significant differences were observed in the decrease in HC, red blood cell transfusion, and ventilator application between the NEC and non-NEC groups. A significant decrease in HC was an independent risk factor for NEC in preterm infants with sepsis. CONCLUSION A significant decrease in HC is an independent risk factor for NEC and may predict the occurrence of NEC in preterm infants with sepsis.
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Affiliation(s)
- Na Cai
- Department of Pediatrics, The First Hospital Affiliated to Army Medical University, Chongqing, China
| | - Wenting Fan
- Department of Pediatrics, The First Hospital Affiliated to Army Medical University, Chongqing, China
| | - Min Tao
- Department of Pediatrics, The First Hospital Affiliated to Army Medical University, Chongqing, China
| | - Wei Liao
- Department of Pediatrics, The First Hospital Affiliated to Army Medical University, Chongqing, China
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Yin Y, Wang J, Zhao X, Wu X, Zou H, Qin Z, Cao J. Overexpressed FOXO3 improves inflammatory status in mice by affecting NLRP3-mediated cell coronation in necrotizing colitis mice. Biomed Pharmacother 2020; 125:109867. [PMID: 32058213 DOI: 10.1016/j.biopha.2020.109867] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To investigate the relationship between FOXO3 overexpression and NLRP3 and explore the effect of FOXO3 on necrotizing colitis. METHODS 100 clean grade newborn SD (Sprague Dawley) rats were randomly divided into 4 groups: NEC group, NEC + FOXO3a group, NEC + NC group and control group. NEC rat model was established by hypoxia + hypothermia stimulation; HE staining was used for detection of the inflammation of intestinal tissue. The histological scores of intestinal tissues were histologically scored, generally, there were three types of inflammatory scoring systems including anatomically based systems, severity-based systems and quality of life systems (Lim et al., 2015) and in this study we utilized severity-based systems by HE staining. Human intestinal epithelial cell line was transfected with recombinant plasmid overexpressing FOXO3a and recombinant plasmid overexpressing NLRP3, and divided into control group, LPS group, LPS + NC group, LPS + FOXO3a group and LPS + FOXO3a + NLRP3 group; Caspase-1 was used for the detection of pyroptosis. The expressions of FOXO3a, NLRP3, cleaved Caspase-1 and the expression of TLR4 in TLR4 signaling pathway were detected by RT-qPCR and WB. IL-1β, IL-6, IL-18 and TNF-α were detected by ELISA. RESULTS (1) FOXO3a is under-expressed and NLRP3 is highly expressed in NEC neonatal rat intestinal tissue. (2) The inflammatory condition of intestinal tissue in NEC + FOXO3a group was improved compared with NEC group (P < 0.05). (3) FOXO3a was highly expressed in NEC + FOXO3a group. The expression of IL-1β, IL-6, IL-18, SOD and MDA in NEC + FOXO3a group was lower than that in NEC group. (4) The expression of IL-1β, IL-6, IL-18, SOD and MDA in intestinal epithelial cells of LPS + FOXO3a group was lower than other groups. (5) Overexpression of FOXO3a inhibits LPS-induced pyroptotic cell death in intestinal epithelial cells by inhibiting NLRP3. CONCLUSION Overexpression of FOXO3 in mice with necrotizing colitis can improve inflammatory conditions in mice by affecting NLRP3-mediated cell caking.
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Affiliation(s)
- Yiyu Yin
- Department of General Surgery, Xuzhou Children's Hospital, Xuzhou Medical University, China
| | - Jian Wang
- Department of General Surgery, Children's Hospital of Soochow University, China
| | - Xiaodong Zhao
- Department of Paediatrics, Nantong First People's Hospital, China
| | - Xiaole Wu
- Department of Anesthesiology, Xuzhou Children's Hospital, Xuzhou Medical University, China
| | - Huaxin Zou
- Department of General Surgery, Xuzhou Children's Hospital, Xuzhou Medical University, China
| | - Zhenfang Qin
- Department of General Surgery, Xuzhou Children's Hospital, Xuzhou Medical University, China
| | - Junhua Cao
- Department of Emergency Medicine, Xuzhou Children's Hospital, Xuzhou Medical University, China.
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Clinical characteristic comparison of low birth weight and very low birth weight preterm infants with neonatal necrotizing enterocolitis: a single tertiary center experience from eastern China. Pediatr Surg Int 2018; 34:1201-1207. [PMID: 30128701 DOI: 10.1007/s00383-018-4339-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE This study aims to understand the clinical characteristics of preterm neonatal necrotizing enterocolitis (NEC) to improve the medical management level. METHODS The clinical characteristics of preterm NEC infants with low birth weight (LBW, ≥ 1500 g) and very low birth weight (VLBW, < 1500 g) were compared. Then, clinical information, including demographics, surgical interventions and morbidity, were collected. RESULTS A total of 149 preterm NEC infants (60 with VLBW and 89 with LBW) were enrolled. Their median birth weight and gestational age were 1600 g and 31 weeks, respectively. Respiratory support and surfactant therapy were more frequent in VLBW infants (90% vs. 38% and 75% vs. 21.3%) than in LBW infants. In addition, 70.5% of these infants were fed by formula before the NEC occurred. Prematurity-associated morbidities were significantly higher in VLBW infants. Furthermore, 12.8% of all NEC infants died at discharge, and mortality was more prevalent in VLBW infants (21.7% vs. 6.7%). The most frequently received surgeries were enterostomy (n = 58), primary anastomosis (n = 42), and peritoneal drainage (n = 2). Multifocal, localized and pan-intestinal disease occurred in 77.5%, 19.6% and three infants, respectively. Furthermore, postoperative complications occurred more frequently in VLBW infants. CONCLUSION The overall mortality was 12.8% for infants who had a larger mean gestational age and birth weight, when compared to that in developed countries. Higher rate of formula feeding might be an important risk factor for NEC development. Furthermore, mortality and morbidities, especially nutrition-associated complications, were more frequent in VLBW infants.
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12
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Hackam DJ, Sodhi CP. Toll-Like Receptor-Mediated Intestinal Inflammatory Imbalance in the Pathogenesis of Necrotizing Enterocolitis. Cell Mol Gastroenterol Hepatol 2018; 6:229-238.e1. [PMID: 30105286 PMCID: PMC6085538 DOI: 10.1016/j.jcmgh.2018.04.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/02/2018] [Indexed: 02/08/2023]
Abstract
Necrotizing enterocolitis (NEC) remains the leading cause of death from gastrointestinal disease in premature infants and attacks the most fragile patients at a time when they appear to be the most stable. Despite significant advances in our overall care of the premature infant, NEC mortality remains stubbornly high. There is no specific treatment for NEC beyond broad-spectrum antibiotics and intestinal resection, and current efforts have focused on preventive strategies. Over the past decade, we have proposed a unifying hypothesis to explain the pathogenesis of NEC in premature infants that suggests that NEC develops in response to an imbalance between exaggerated proinflammatory signaling in the mucosa of the premature gut leading to mucosal injury, which is not countered effectively by endogenous repair processes, and in the setting of impaired mesenteric perfusion leads to intestinal ischemia and disease development. One of the most important pathways that mediates the balance between injury and repair in the premature intestine, and that plays a key role in NEC pathogenesis, is Toll-like receptor 4 (TLR4), which recognizes lipopolysaccharide on gram-negative bacteria. This review focuses on the role that the TLR4-mediated imbalance between proinflammatory and anti-inflammatory signaling in the premature intestinal epithelium leads to the development of NEC, and will explore how an understanding of the role of TLR4 in NEC pathogenesis has led to the identification of novel preventive or treatment approaches for this devastating disease.
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MESH Headings
- Enterocolitis, Necrotizing/metabolism
- Enterocolitis, Necrotizing/microbiology
- Enterocolitis, Necrotizing/pathology
- Humans
- Infant
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/metabolism
- Infant, Premature, Diseases/microbiology
- Infant, Premature, Diseases/pathology
- Inflammation/metabolism
- Inflammation/microbiology
- Inflammation/pathology
- Intestinal Mucosa/metabolism
- Intestinal Mucosa/microbiology
- Intestinal Mucosa/pathology
- Milk, Human/metabolism
- Mortality, Premature
- Risk Factors
- Toll-Like Receptor 4/metabolism
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Affiliation(s)
- David J. Hackam
- Division of General Pediatric Surgery, Johns Hopkins University, Johns Hopkins Hospital, Baltimore, Maryland
- Johns Hopkins Children’s Center, Johns Hopkins Hospital, Baltimore, Maryland
| | - Chhinder P. Sodhi
- Division of General Pediatric Surgery, Johns Hopkins University, Johns Hopkins Hospital, Baltimore, Maryland
- Johns Hopkins Children’s Center, Johns Hopkins Hospital, Baltimore, Maryland
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13
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Qian T, Zhang R, Zhu L, Shi P, Yang J, Yang CY, Chen DM, Shi JY, Zhou XG, Qiu YP, Yang Y, He L, He SR, Cao YT, Wei QF, Kumar M, Chen C. Necrotizing enterocolitis in low birth weight infants in China: Mortality risk factors expressed by birth weight categories. Pediatr Neonatol 2017; 58:509-515. [PMID: 28528756 DOI: 10.1016/j.pedneo.2016.10.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/21/2016] [Accepted: 10/14/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND We retrospectively investigated incidence, morbidity, and mortality of neonatal necrotizing enterocolitis in China, with special emphasis on determining the predictors of necrotizing enterocolitis associated mortality. METHODS We identified neonates as having necrotizing enterocolitis if they met the accepted diagnostic criterion. Data pertaining to antenatal period, labor and birth, and the postnatal course of illness were collected. Multivariate analysis and logistic regression were used to analyze the risk factors. RESULTS There were 1167 cases of necrotizing enterocolitis identified from the 95 participating NICUs in mainland China in 2011, with the incidence of 2.50% and 4.53% in LBW (birth weight <2500 g) and VLBW (birth weight <1500 g) infants, respectively. Stage 1, 2 and 3 diseases were noted in 51.1%, 30.3% and 18.6% of cases respectively. The mortality from stage 2 and 3 necrotizing enterocolitis in this cohort was 41.7%. In VLBW infants, the important risk factors for mortality were small for gestation age (OR: 5.02, 95% CI 1.73-14.6; P = 0.003) and stage 3 NEC (OR: 8.09, 95% CI 2.80-23.3, P < 0.001). In moderate LBW infants (birth weight 1500-2499 g), the risk factors identified for mortality were sepsis during hospitalization (OR: 2.59, 95% CI 1.57-4.28, P < 0.001) and stage 3 NEC (OR: 5.37, 95% CI 3.24-8.90; P < 0.001). CONCLUSIONS Necrotizing enterocolitis remains an important cause of morbidity and mortality in prematurely born neonates in Chinese neonatal units. Awareness of the associated risk factors and appropriate interventions may improve the outcome of necrotizing enterocolitis in different birth weight subgroup.
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Affiliation(s)
- Tian Qian
- Children's Hospital of Fudan University and the Laboratory of Neonatal Diseases of Ministry of Health, Shanghai, China
| | - Rong Zhang
- Children's Hospital of Fudan University and the Laboratory of Neonatal Diseases of Ministry of Health, Shanghai, China
| | - Li Zhu
- Children's Hospital of Fudan University and the Laboratory of Neonatal Diseases of Ministry of Health, Shanghai, China
| | - Peng Shi
- Children's Hospital of Fudan University and the Laboratory of Neonatal Diseases of Ministry of Health, Shanghai, China
| | - Jie Yang
- Guangdong Provincial Maternity Hospital, Guangzhou, China
| | | | | | - Jing-Yun Shi
- Gansu Provincial Maternity Hospital, Lanzhou, China
| | - Xiao-Guang Zhou
- Nanjing Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yin-Ping Qiu
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yong Yang
- Dongguan Maternity Hospital, Dongguan, China
| | - Ling He
- Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Shao-Ru He
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yun-Tao Cao
- Affiliated Hospital of Zunyi Medical College, Zunyi, China
| | - Qiu-Fen Wei
- Maternal and Child Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | | | - Chao Chen
- Children's Hospital of Fudan University and the Laboratory of Neonatal Diseases of Ministry of Health, Shanghai, China.
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14
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Figueira RL, Gonçalves FL, Simões AL, Bernardino CA, Lopes LS, Castro E Silva O, Sbragia L. Brain caspase-3 and intestinal FABP responses in preterm and term rats submitted to birth asphyxia. ACTA ACUST UNITED AC 2017; 49:S0100-879X2016000700703. [PMID: 27356106 PMCID: PMC4926528 DOI: 10.1590/1414-431x20165258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/21/2016] [Indexed: 11/22/2022]
Abstract
Neonatal asphyxia can cause irreversible injury of multiple organs resulting in
hypoxic-ischemic encephalopathy and necrotizing enterocolitis (NEC). This injury is
dependent on time, severity, and gestational age, once the preterm babies need
ventilator support. Our aim was to assess the different brain and intestinal effects
of ischemia and reperfusion in neonate rats after birth anoxia and mechanical
ventilation. Preterm and term neonates were divided into 8 subgroups (n=12/group): 1)
preterm control (PTC), 2) preterm ventilated (PTV), 3) preterm asphyxiated (PTA), 4)
preterm asphyxiated and ventilated (PTAV), 5) term control (TC), 6) term ventilated
(TV), 7) term asphyxiated (TA), and 8) term asphyxiated and ventilated (TAV). We
measured body, brain, and intestine weights and respective ratios [(BW), (BrW), (IW),
(BrW/BW) and (IW/BW)]. Histology analysis and damage grading were performed in the
brain (cortex/hippocampus) and intestine (jejunum/ileum) tissues, as well as
immunohistochemistry analysis for caspase-3 and intestinal fatty acid-binding protein
(I-FABP). IW was lower in the TA than in the other terms (P<0.05), and the IW/BW
ratio was lower in the TA than in the TAV (P<0.005). PTA, PTAV and TA presented
high levels of brain damage. In histological intestinal analysis, PTAV and TAV had
higher scores than the other groups. Caspase-3 was higher in PTAV (cortex) and TA
(cortex/hippocampus) (P<0.005). I-FABP was higher in PTAV (P<0.005) and TA
(ileum) (P<0.05). I-FABP expression was increased in PTAV subgroup (P<0.0001).
Brain and intestinal responses in neonatal rats caused by neonatal asphyxia, with or
without mechanical ventilation, varied with gestational age, with increased
expression of caspase-3 and I-FABP biomarkers.
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Affiliation(s)
- R L Figueira
- Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F L Gonçalves
- Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A L Simões
- Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C A Bernardino
- Neurocirurgia, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L S Lopes
- Neurocirurgia, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - O Castro E Silva
- Divisão de Transplante, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L Sbragia
- Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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15
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Blackwood BP, Yuan CY, Wood DR, Nicolas JD, Grothaus JS, Hunter CJ. Probiotic Lactobacillus Species Strengthen Intestinal Barrier Function and Tight Junction Integrity in Experimental Necrotizing Enterocolitis. ACTA ACUST UNITED AC 2017. [PMID: 28638850 PMCID: PMC5475283 DOI: 10.4172/2329-8901.1000159] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Necrotizing enterocolitis (NEC) is a serious intestinal disease that occurs in newborn infants. It is associated with major morbidity and affects 5% of all infants admitted to neonatal intensive care units. Probiotics have variable efficacy in preventing necrotizing enterocolitis. Tight junctions (TJ) are protein complexes that maintain epithelial barrier integrity. We hypothesized that the probiotics Lactobacillus rhamnosus and Lactobacillus plantarum strengthen intestinal barrier function, promote TJ integrity, and protect against experimental NEC. Both an in vitro and an in vivo experimental model of NEC were studied. Cultured human intestinal Caco-2 cells were pretreated with L. rhamnosus and L. plantarum probiotics. TJ were then disrupted by EGTA calcium switch or LPS to mimic NEC in vitro. Trans-epithelial resistance (TER) and flux of fluorescein isothiocynate dextran was measured. TJ structure was evaluated by ZO-1 immunofluorescence. In vivo effects of ingested probiotics on intestinal injury and ZO-1 expression were assessed in a rat model of NEC infected with Cronobacter sakazakii (CS). Caco-2 cells treated with individual probiotics demonstrated higher TER and lower permeability compared to untreated cells (p<0.0001). ZO-1 immunofluorescence confirmed TJ stability in treated cells. Rat pups fed probiotics alone had more intestinal injury compared with controls (p=0.0106). Probiotics were protective against injury when given in combination with CS, with no difference in intestinal injury compared to controls (p=0.21). Increased permeability was observed in the probiotic and CS groups (p=0.03, p=0.05), but not in the probiotic plus CS group (p=0.79). Lactobacillus sp. strengthened intestinal barrier function and preserved TJ integrity in an in vitro experimental model of NEC. In vivo, probiotic bacteria were not beneficial when given alone, but were protective in the presence of CS in a rat model of NEC.
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Affiliation(s)
- Brian P Blackwood
- Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatric Surgery, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Department of Pediatrics, Chicago, Illinois, USA
| | - Carrie Y Yuan
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, Chicago, Illinois, USA
| | - Douglas R Wood
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, Chicago, Illinois, USA
| | - Joseph D Nicolas
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, Chicago, Illinois, USA
| | - Justyna S Grothaus
- Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatric Surgery, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Department of Pediatrics, Chicago, Illinois, USA
| | - Catherine J Hunter
- Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatric Surgery, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Department of Pediatrics, Chicago, Illinois, USA
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16
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Anderson S. Probiotics for Preterm Infants: A Premature or Overdue Necrotizing Enterocolitis Prevention Strategy? Neonatal Netw 2016; 34:83-101. [PMID: 26803090 DOI: 10.1891/0730-0832.34.2.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Common among preterm, very low birth weight (VLBW) and extremely low birth weight (ELBW) infants, necrotizing enterocolitis (NEC) is a gastrointestinal, infectious disease that remains a leading cause of morbidity and mortality among this high-risk population. To combat this devastating condition, research efforts have been redirected from treatment toward prevention strategies. Although there are several proposed risk-reduction strategies, one intervention gaining support is the administration of prophylactic enteral probiotics. Regardless of growing evidentiary support and a benign safety profile, neonatal providers have yet to embrace this therapy. This article provides an overview of the proposed benefits of probiotics, focusing on their role as a NEC prevention strategy. A review of several sentinel research studies targeting preterm, VLBW, and ELBW infants is provided. Considerations for ongoing research are reviewed. Finally, two evidence-based NEC prevention probiotics protocols are presented.
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Zhang Y, Ma JK, Wei H, Li XW, Li LQ, Yu JL. Predictive scores for mortality in full-term infants with necrotizing enterocolitis: experience of a tertiary hospital in Southwest China. World J Pediatr 2016; 12:202-8. [PMID: 26684312 DOI: 10.1007/s12519-015-0063-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 10/23/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although many risk factors for mortality of necrotizing enterocolitis (NEC) were investigated, most of them were obtained from preterm infants, and few works focused on the prognostic risk factors in fullterm infants. This study aimed to identify risk factors and develop a prediction score model for mortality in fullterm neonates with NEC. METHODS The risk factors were analyzed retrospectively by bivariate and multivariate logistic regression analysis in 153 full-term neonates with NEC, who were hospitalized in Children's Hospital of Chongqing Medical University from 2000 to 2013. A prediction score model was developed according to the regression coefficients of risk factors. RESULTS The mortality of the infants was 19.6% (30/153). The non-survivors had a younger age of diagnosis and advanced stage of NEC (P<0.05). They had a higher prevalence of respiratory failure, intestinal perforation, peritonitis and other complications, compared with the survivors (P<0.05). On the day of diagnosis, the nonsurvivors were more likely to have abnormal laboratory indicators than survivors (P<0.05). Age at diagnosis [odds ratio (OR)=0.91, 95% confidence interval (CI)=0.836-0.99], respiratory failure (OR=2.76, 95% CI=1.10-6.92), and peritonitis (OR=26.36, 95% CI=7.52-173.92) had significant independent contributions to death. A score model predicting death was developed, and the area under the receiver operating characteristic curve was 0.869 (95% CI=0.803-0.935). All infants with scores ≥8 died. CONCLUSION Younger age at diagnosis, peritonitis, and respiratory failure might be risk factors for the mortality of full-term infants with NEC. Infants with a predictive score of 8 were at high risk for death.
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Affiliation(s)
- Yu Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Ji-Kun Ma
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Hong Wei
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Xiao-Wen Li
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Lu-Quan Li
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China.
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, 400014, China.
| | - Jia-Lin Yu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
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18
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Kim SH, Park JH, Moon CJ, Lim GY, Kim SY. Presentation Time of Necrotizing Enterocolitis Diagnosed by Sonography according to Gestational Age. NEONATAL MEDICINE 2015. [DOI: 10.5385/nm.2015.22.1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- So Hyun Kim
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joo Hyung Park
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chung Joon Moon
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gye-Yeon Lim
- Department of Radiology, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Young Kim
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Seoul, Korea
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