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Ding XP, Hu XW, Chen S, Guo L, Wang ZL, He Y, Li LQ, Tang WY. Risk factors for necrotizing enterocolitis in small-for-gestational-age infants: a matched case-control study. Sci Rep 2024; 14:19098. [PMID: 39154081 PMCID: PMC11330453 DOI: 10.1038/s41598-024-70351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 08/14/2024] [Indexed: 08/19/2024] Open
Abstract
Few studies have focused on the risk factors for necrotizing enterocolitis (NEC) in small for gestational age (SGA) infants. The aim of this study was to identify the risk factors for NEC in SGA newborns. This study included consecutive SGA neonates admitted to a tertiary hospital in Jiangxi Province, China from Jan 2008 to Dec 2022. Patients with NEC (Bell's stage ≥ II) were assigned to the NEC group. Gestational age- and birth weight-matched non-NEC infants born during the same period at the same hospital were assigned to the control group. The risk factors associated with NEC were analyzed with univariate and logistic regression models. During the study period, 2,912 SGA infants were enrolled, 150 (5.15%) of whom developed NEC. In total, 143 patients and 143 controls were included in the NEC and control groups, respectively. Logistic regression analysis revealed that sepsis (OR 2.399, 95% CI 1.271-4.527, P = 0.007) and anemia (OR 2.214, 95% CI 1.166-4.204, P = 0.015) might increase the incidence of NEC in SGA infants and that prophylactic administration of probiotics (OR 0.492, 95% CI 0.303-0.799, P = 0.004) was a protective factor against NEC. Therefore, sepsis, anemia and a lack of probiotic use are independent risk factors for NEC in SGA infants.
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Affiliation(s)
- Xiang-Ping Ding
- Department of Neonatology, Jiangxi Hospital Affiliated to Children's Hospital of Chongqing Medical University, Nanchang, 330103, People's Republic of China
| | - Xiang-Wen Hu
- Department of Neonatology, Jiangxi Hospital Affiliated to Children's Hospital of Chongqing Medical University, Nanchang, 330103, People's Republic of China
| | - Shi Chen
- Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Neonatal Diagnosis and Treatment Center, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Lu Guo
- Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Neonatal Diagnosis and Treatment Center, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Zheng-Li Wang
- Department of Neonatology, Jiangxi Hospital Affiliated to Children's Hospital of Chongqing Medical University, Nanchang, 330103, People's Republic of China
- Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Neonatal Diagnosis and Treatment Center, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Yu He
- Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Neonatal Diagnosis and Treatment Center, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Lu-Quan Li
- Department of Neonatology, Jiangxi Hospital Affiliated to Children's Hospital of Chongqing Medical University, Nanchang, 330103, People's Republic of China
- Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Neonatal Diagnosis and Treatment Center, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Wen-Yan Tang
- Department of Neonatology, Jiangxi Hospital Affiliated to Children's Hospital of Chongqing Medical University, Nanchang, 330103, People's Republic of China.
- Jiangxi Maternal and Child Health Hospital, Maternal and Child Health Hospital of Nanchang Medical College, Nan Chan, 330038, Jiangxi, China.
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Wang D, Zhang F, Pan J, Yuan T, Jin X. Influencing factors for surgical treatment in neonatal necrotizing enterocolitis: a systematic review and meta-analysis. BMC Pediatr 2024; 24:512. [PMID: 39123165 PMCID: PMC11312808 DOI: 10.1186/s12887-024-04978-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is a complex disease characterized by gastrointestinal inflammation and is one of the most common gastrointestinal emergencies in neonates. Mild to moderate cases of NEC require medical treatment, whereas severe cases necessitate surgical intervention. However, evidence for surgical indications is limited and largely dependent on the surgeon's experience, leading to variability in outcomes. The primary aim of this study is to identify the risk factors for surgical intervention in neonatal NEC, which will aid in predicting the optimal timing for surgical intervention. METHODS A literature search was conducted in PubMed, Embase, and Web of Science databases for case-control studies exploring risk factors for NEC requiring surgical intervention. The search was completed on June 16, 2024, and data analysis was performed using R Studio 4.3.2. RESULTS 18 studies were included, comprising 1,104 cases in the surgery group and 1,686 in the medical treatment group. The meta-analysis indicated that high C-reactive protein (CRP) levels [OR = 1.42, 95% CI (1.01, 1.99)], lower gestational age [OR = 0.52, 95% CI (0.3, 0.91)], sepsis [OR = 2.94, 95% CI (1.87, 4.60)], coagulation disorder [OR = 3.45, 95% CI (1.81, 6.58)], lack of enteral feeding [OR = 3.18, 95% CI (1.37, 7.35)], and hyponatremia [OR = 1.22, 95% CI (1.07, 1.39)] are significant risk factors for surgical treatment in neonatal NEC. CONCLUSIONS High CRP levels, coagulation disorders, sepsis, lower gestational age, lack of enteral feeding, and hyponatremia are significant risk factors for surgical intervention in neonatal NEC. These findings have potential clinical significance for predicting surgical risk.
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Affiliation(s)
- Dandan Wang
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333#, Bin Sheng Road, Hangzhou, Zhejiang, 310052, P.R. China
| | - Fanhui Zhang
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333#, Bin Sheng Road, Hangzhou, Zhejiang, 310052, P.R. China
| | - Jiarong Pan
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333#, Bin Sheng Road, Hangzhou, Zhejiang, 310052, P.R. China
| | - Tianming Yuan
- Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333#, Bin Sheng Road, Hangzhou, Zhejiang, 310052, P.R. China
| | - Xuefeng Jin
- Department of Gastroenterology, Hangzhou Children's Hospital, 195#, Wen Hui Road, Gong Shu Distric, Hangzhou, Zhejiang, 310014, P.R. China.
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3
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Wang Y, Liu S, Lu M, Huang T, Huang L. Neurodevelopmental outcomes of preterm with necrotizing enterocolitis: a systematic review and meta-analysis. Eur J Pediatr 2024; 183:3147-3158. [PMID: 38684534 PMCID: PMC11263237 DOI: 10.1007/s00431-024-05569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024]
Abstract
While neonatal necrotising enterocolitis (NEC) is associated with high mortality rates in newborns, survivors can face long-term sequelae. However, the relationship between NEC and neurodevelopmental impairment (NDI) in preterm infants remains unclear. To explore the relationship between neonatal NEC and neurodevelopmental outcomes in preterm infants, we searched PubMed, EMBASE, and the Cochrane Library from their inception to February 2024 for relevant studies. Studies included were cohort or case-control studies reporting neurodevelopmental outcomes of NEC in preterm infants. Two independent investigators extracted data regarding brain damage and neurodevelopmental outcomes in these infants at a corrected age exceeding 12 months. Odds ratios (ORs) were pooled using a random effects model. We included 15 cohort studies and 18 case-control studies, encompassing 60,346 infants. Meta-analysis of unadjusted and adjusted ORs demonstrated a significant association between NEC and increased odds of NDI (OR 2.15, 95% CI 1.9-2.44; aOR 1.89, 95% CI 1.46-2.46). Regarding brain injury, pooled crude ORs indicated an association of NEC with severe intraventricular haemorrhage (IVH) (OR 1.42, 95% CI 1.06-1.92) and periventricular leucomalacia (PVL) (OR 2.55, 95% CI 1.76-3.69). When compared with conservatively treated NEC, surgical NEC potentially carries a higher risk of NDI (OR 1.78, 95% CI 1.09-2.93) and severe IVH (OR 1.57, 95% CI 1.20-2.06). However, the risk of PVL did not show a significant difference (OR 1.60, 95% CI 0.47-5.40). CONCLUSIONS Our meta-analysis provides evidence suggesting an association between NEC and NDI. Additionally, the severity of intestinal lesions appears to correlate with a higher risk of NDI. Further high-quality studies with comprehensive adjustments for potential confounding factors are required to definitively establish whether the association with NDI is causal. WHAT IS KNOWN • NEC is a serious intestinal disease in the neonatal period with a high mortality rate, and surviving children may have digestive system sequelae. • Compared with non-NEC preterm infants, the reported incidences of brain injury and neurodevelopmental disorders in NEC preterm infants are not the same. WHAT IS NEW • The risk of neonatal brain injury and neurodevelopmental disorders in preterm infants with NEC is higher than that in non-NEC infants, and the risk of NDI in surgical NEC infants is higher than that in the conservative treatment group. • NEC may increase the risk of motor, cognitive, language development delays, and attention deficits in children.
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Affiliation(s)
- Yan Wang
- Department of Emergency, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Shunli Liu
- Department of Emergency, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Meizhu Lu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Tao Huang
- Department of Emergency, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Lan Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
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Butler V, Treluyer L, Patkaï J, Biset A, Jarreau PH, Ancel PY, Rozé JC, Marchand-Martin L, Durox M, Lapillonne A, Picaud JC, Mitanchez D, Tscherning C, Biran V, Cambonie G, Lopez E, Hascoet JM, Desfrere L, Chollat C, Zana-Taïeb E, Torchin H. Mortality and neurodevelopmental outcomes at 2 years' corrected age of very preterm infants with necrotising enterocolitis or spontaneous intestinal perforation: The EPIPAGE-2 cohort study. Eur J Pediatr 2024:10.1007/s00431-024-05675-4. [PMID: 38955846 DOI: 10.1007/s00431-024-05675-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE The primary objective was to evaluate the impact of necrotising enterocolitis (NEC) and spontaneous intestinal perforation (SIP) on mortality and neurodevelopmental outcomes at 2 years' corrected age (CA) in infants born before 32 weeks' gestation (WG). METHODS We studied neurodevelopment at 2 years' CA of infants with NEC or SIP who were born before 32 WG from the EPIPAGE-2 cohort study. The primary outcome was death or the presence of moderate-to-severe motor or sensory disability defined by moderate-to-severe cerebral palsy or hearing or visual disability. The secondary outcome was developmental delay defined by a score < 2 SDs below the mean for any of the five domains of the Ages and Stages Questionnaire. RESULTS At 2 years' CA, 46% of infants with SIP, 34% of infants with NEC, and 14% of control infants died or had a moderate-to-severe sensorimotor disability (p < 0.01). This difference was mainly due to an increase in in-hospital mortality in the infants with SIP or NEC. Developmental delay at 2 years' CA was more frequent for infants with SIP than controls (70.8% vs 44.0%, p = 0.02) but was similar for infants with NEC and controls (49.3% vs 44.0%, p = 0.5). On multivariate analysis, the likelihood of developmental delay was associated with SIP (adjusted odds ratio = 3.0, 95% CI 1.0-9.1) but not NEC as compared with controls. CONCLUSION NEC and SIP significantly increased the risk of death or sensorimotor disability at 2 years' CA. SIP was also associated with risk of developmental delay at 2 years' CA.
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Grants
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- ANR-11-EQPX-0038 and ANR-19-COHO001 Centre National de la Recherche Scientifique
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- 11779 Fondation de France
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- SPF20160936356 Fondation pour la Recherche Médicale
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- DGOS13-040 Epinutri
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- G13129KK Ministère de l'Enseignement Supérieur, De La Recherche et de L'Innovation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
- R20065KK Apicil Foundation
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Affiliation(s)
- Victoria Butler
- Neonatal Intensive Care Unit, Assistance Publique - Hôpitaux de Paris, Paris Cité University, Cochin Hospital, 53 Avenue de L'Observatoire, Paris, 75014, France.
| | - Ludovic Treluyer
- Neonatal Intensive Care Unit, Assistance Publique - Hôpitaux de Paris, Paris Cité University, Cochin Hospital, 53 Avenue de L'Observatoire, Paris, 75014, France
- Paris Cité University, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, 75006, France
| | - Juliana Patkaï
- Neonatal Intensive Care Unit, Assistance Publique - Hôpitaux de Paris, Paris Cité University, Cochin Hospital, 53 Avenue de L'Observatoire, Paris, 75014, France
| | - Aline Biset
- Department of Neonatal Paediatrics, Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Pierre-Henri Jarreau
- Neonatal Intensive Care Unit, Assistance Publique - Hôpitaux de Paris, Paris Cité University, Cochin Hospital, 53 Avenue de L'Observatoire, Paris, 75014, France
- Paris Cité University, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, 75006, France
- FHU Prema, Paris, France
| | - Pierre-Yves Ancel
- Paris Cité University, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, 75006, France
- FHU Prema, Paris, France
- Clinical Investigation Center P1419, Assistance Publique - Hôpitaux de Paris, Paris, France
- Nutrition EPIPAGE-2 Study Group, Paris, France
| | - Jean-Christophe Rozé
- Nutrition EPIPAGE-2 Study Group, Paris, France
- Department of Neonatology, CHU Nantes, Nantes, France
- UMR PhAN 1280 INRAE, CIC004 INSERM, Nantes, France
| | - Laetitia Marchand-Martin
- Paris Cité University, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, 75006, France
- Nutrition EPIPAGE-2 Study Group, Paris, France
| | - Mélanie Durox
- Paris Cité University, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, 75006, France
- Nutrition EPIPAGE-2 Study Group, Paris, France
| | - Alexandre Lapillonne
- Nutrition EPIPAGE-2 Study Group, Paris, France
- Neonatal Intensive Care Unit, Assistance Publique - Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France
- URP 7328, Paris Cité University, Paris, France
| | - Jean-Charles Picaud
- Nutrition EPIPAGE-2 Study Group, Paris, France
- Department of Neonatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, 69677, France
- CarMen, INSERM, INRA, Université Claude Bernard Lyon 1, Pierre-Bénite, Lyon, 69310, France
| | - Delphine Mitanchez
- Nutrition EPIPAGE-2 Study Group, Paris, France
- Department of Neonatology, Bretonneau Hospital, François Rabelais University, Tours, 37000, France
| | - Charlotte Tscherning
- Nutrition EPIPAGE-2 Study Group, Paris, France
- Division of Neonatology, Oslo University Hospital, Oslo, 0372, Norway
- Infinity, University of Toulouse, INSERM, CNRS, UPS, Toulouse, France
| | - Valérie Biran
- Nutrition EPIPAGE-2 Study Group, Paris, France
- Neonatal Intensive Care Unit, Assistance Publique - Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- INSERM U1141, Paris Cité University, Paris, France
| | - Gilles Cambonie
- Nutrition EPIPAGE-2 Study Group, Paris, France
- Department of Neonatology, CHU Montpellier, Montpellier University, Montpellier, France
- INSERM UMR 1058, University of Montpellier, Montpellier, France
| | | | - Jean-Michel Hascoet
- Nutrition EPIPAGE-2 Study Group, Paris, France
- Neonatology Department, Maternité Régionale Universitaire Adolphe Pinard - Nancy University, Nancy, France
- DevAH, University of Lorraine, Vandoeuvre-Les-Nancy, France
| | - Luc Desfrere
- Nutrition EPIPAGE-2 Study Group, Paris, France
- Neonatal Intensive Care Unit, Assistance Publique - Hôpitaux de Paris, Louis Mourier Hospital, Colombes, France
| | - Clément Chollat
- Department of Neonatal Paediatrics, Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne University, Paris, France
- NeuroDiderot, INSERM, Paris Cité University, Paris, France
| | - Elodie Zana-Taïeb
- Neonatal Intensive Care Unit, Assistance Publique - Hôpitaux de Paris, Paris Cité University, Cochin Hospital, 53 Avenue de L'Observatoire, Paris, 75014, France
- INSERM U955, IMRB, Créteil, France
| | - Héloïse Torchin
- Neonatal Intensive Care Unit, Assistance Publique - Hôpitaux de Paris, Paris Cité University, Cochin Hospital, 53 Avenue de L'Observatoire, Paris, 75014, France
- Paris Cité University, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, 75006, France
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5
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Bernhard W, Böckmann KA, Minarski M, Wiechers C, Busch A, Bach D, Poets CF, Franz AR. Evidence and Perspectives for Choline Supplementation during Parenteral Nutrition-A Narrative Review. Nutrients 2024; 16:1873. [PMID: 38931230 PMCID: PMC11206924 DOI: 10.3390/nu16121873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/03/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
Choline is an essential nutrient, with high requirements during fetal and postnatal growth. Tissue concentrations of total choline are tightly regulated, requiring an increase in its pool size proportional to growth. Phosphatidylcholine and sphingomyelin, containing a choline headgroup, are constitutive membrane phospholipids, accounting for >85% of total choline, indicating that choline requirements are particularly high during growth. Daily phosphatidylcholine secretion via bile for lipid digestion and very low-density lipoproteins for plasma transport of arachidonic and docosahexaenoic acid to other organs exceed 50% of its hepatic pool. Moreover, phosphatidylcholine is required for converting pro-apoptotic ceramides to sphingomyelin, while choline is the source of betaine as a methyl donor for creatine synthesis, DNA methylation/repair and kidney function. Interrupted choline supply, as during current total parenteral nutrition (TPN), causes a rapid drop in plasma choline concentration and accumulating deficit. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) defined choline as critical to all infants requiring TPN, claiming its inclusion in parenteral feeding regimes. We performed a systematic literature search in Pubmed with the terms "choline" and "parenteral nutrition", resulting in 47 relevant publications. Their results, together with cross-references, are discussed. While studies on parenteral choline administration in neonates and older children are lacking, preclinical and observational studies, as well as small randomized controlled trials in adults, suggest choline deficiency as a major contributor to acute and chronic TPN-associated liver disease, and the safety and efficacy of parenteral choline administration for its prevention. Hence, we call for choline formulations suitable to be added to TPN solutions and clinical trials to study their efficacy, particularly in growing children including preterm infants.
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Affiliation(s)
- Wolfgang Bernhard
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Katrin A. Böckmann
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Michaela Minarski
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Cornelia Wiechers
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Annegret Busch
- Pharmaceutical Department, University Hospital, 72076 Tübingen, Germany; (A.B.); (D.B.)
| | - Daniela Bach
- Pharmaceutical Department, University Hospital, 72076 Tübingen, Germany; (A.B.); (D.B.)
| | - Christian F. Poets
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Axel R. Franz
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
- Center for Pediatric Clinical Studies, University Children’s Hospital, 72076 Tübingen, Germany
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Wang Y, Cui M, Li L, Gao C, Feng Z, Cai Y, Yang Z, Shen L. Unexpected decrease in necrotizing enterocolitis morbidity during the COVID-19 pandemic-A single-centre retrospective study. Front Pediatr 2024; 12:1346478. [PMID: 38863524 PMCID: PMC11165084 DOI: 10.3389/fped.2024.1346478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/15/2024] [Indexed: 06/13/2024] Open
Abstract
Background The impact of the coronavirus disease 2019 (COVID-19) pandemic on neonatal necrotizing enterocolitis (NEC) is not well characterised. This cross-sectional study evaluated the potential effects of pandemic-related measures on NEC morbidity in premature infants in a neonatal ward during the COVID-19 pandemic. Methods This was a retrospective study conducted in a tertiary neonatal ward in eastern and central China over 6 consecutive years (2017, 2018, 2019, 2020, 2021 and 2022). The medical records of 189 premature infants with stage II or III NEC were reviewed for clinical manifestations and aetiologies. The data were analysed and compared between the prepandemic period (2017, 2018, and 2019) and the pandemic period (2020, 2021 and 2022). Results A total of 9,903 infants with gestational age (GA) < 37 weeks were enrolled, including 5,382 in the prepandemic period and 4,521 in the pandemic period. A reduction in stage II or III NEC morbidity was observed in infants with GA < 37 weeks, with an average annual morbidity of 2.29% (123/5,382) (95% CI, 1.89%-2.68%) in the prepandemic period and 1.46% (66/4,521) (95% CI, 1.11%-1.81%) in the pandemic period. NEC morbidity showed resurgent characteristics in 2021. When prepandemic coinfections were excluded, most cases of NEC with bloodstream infections in the prepandemic period were attributable to Gram-negative bacteria (27/32, 84.38%), mainly Klebsiella pneumoniae, while in the pandemic period they were attributable to Gram-positive bacteria (10/18, 55.56%), mainly Staphylococcus aureus. Antimicrobial susceptibility testing revealed that Klebsiella pneumoniae was 100% sensitive to meropenem, imipenem, ciprofloxacin and levofloxacin and 100% resistant to ampicillin. Staphylococcus capitis was 100% sensitive to vancomycin, linezolid, tetracycline, cotrimoxazole and cefoxitin and 100% resistant to penicillin and benzathine. Conclusions COVID-19 pandemic-related interventions can reduce the morbidity of NEC and change the pathogen spectrum in patients with bloodstream infections. We need to understand the exact factors leading to these changes.
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Affiliation(s)
| | | | | | | | | | | | | | - Lirong Shen
- Department of Neonatology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
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Siddiqui A, Haider R, Aaqil SI, Vohra LI, Qamar K, Jawed A, Fatima N, Adnan A, Parikh V, Ochani S, Hasibuzzaman MA. Probiotic formulations and gastro-intestinal diseases in the paediatric population: a narrative review. Ann Med Surg (Lond) 2024; 86:2836-2847. [PMID: 38694362 PMCID: PMC11060255 DOI: 10.1097/ms9.0000000000002007] [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: 09/07/2023] [Accepted: 03/17/2024] [Indexed: 05/04/2024] Open
Abstract
Background/Aim Probiotics are live microbial supplements that improve the microbial balance in the host animal when administered in adequate amounts. They play an important role in relieving symptoms of many diseases associated with gastrointestinal tract, for example, in necrotizing enterocolitis (NEC), antibiotic-associated diarrhea, relapsing Clostridium difficile colitis, Helicobacter pylori infections, and inflammatory bowel disease (IBD). In this narrative review, the authors aim to evaluate the role of different probiotic formulations in treating gastrointestinal diseases in pediatric population aged 18 years or younger and highlight the main considerations for selecting probiotic formulations for use in this population. Methodology The authors searched PubMed and Clinicaltrials.gov from inception to 24th July 2022, without any restrictions. Using an iterative process, the authors subsequently added papers through hand-searching citations contained within retrieved articles and relevant systematic reviews and meta-analyses. Results The effectiveness of single-organism and composite probiotics in treating gastrointestinal disorders in pediatric patients aged 18 or under were analyzed and compared in this study. A total of 39 studies were reviewed and categorized based on positive and negative outcomes, and compared with a placebo, resulting in 25 studies for single-organism and 14 studies for composite probiotics. Gastrointestinal disorders studied included NEC, acute gastroenteritis (AGE), Acute Diarrhea, Ulcerative Colitis (UC), and others. The results show that probiotics are effective in treating various gastrointestinal disorders in children under 18, with single-organism probiotics demonstrating significant positive outcomes in most studies, and composite probiotics showing positive outcomes in all studies analyzed, with a low incidence of negative outcomes for both types. Conclusion This study concludes that single-organism and composite probiotics are effective complementary therapies for treating gastrointestinal disorders in the pediatric population. Hence, healthcare professionals should consider using probiotics in standard treatment regimens, and educating guardians can enhance the benefits of probiotic therapy. Further research is recommended to identify the optimal strains and dosages for specific conditions and demographics. The integration of probiotics in clinical practice and ongoing research can contribute to reducing the incidence and severity of gastrointestinal disorders in pediatric patients.
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Affiliation(s)
- Amna Siddiqui
- Department of Medicine, Karachi Medical and Dental College
| | - Ramsha Haider
- Department of Medicine, Karachi Medical and Dental College
| | | | | | - Khulud Qamar
- Department of Medicine, Dow University of Health and Sciences, Karachi
| | - Areesha Jawed
- Department of Medicine, Dow University of Health and Sciences, Karachi
| | - Nabeela Fatima
- Mentor, International Society of Chronic Illnesses, India
| | - Alishba Adnan
- Department of Medicine, Karachi Medical and Dental College
| | - Vidhi Parikh
- Parul Institute of Medical Sciences and Research, Parul University, Vadodara
| | - Sidhant Ochani
- Department of Medicine, Khairpur Medical College, Khairpur Mir’s, Pakistan
| | - Md. Al Hasibuzzaman
- Institute of Nutrition and Food Sciences, University of Dhaka, Dhaka, Bangladesh
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Tomotaki S, Isayama T, Kobayashi T, Masutani S, Kawasaki H, Nakayama A, Ikeda T, Toyoshima K. Proactive Diagnosis and Tailor-Made Treatment of Patent Ductus Arteriosus in Very Preterm Infants with Routine Echocardiography in Japan: A post hoc Analysis of the PLASE Study. Neonatology 2024; 121:503-511. [PMID: 38593757 DOI: 10.1159/000538363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/12/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION A feature of the management of extremely preterm infants in Japan is proactive circulatory management using early routine echocardiography performed by neonatologists. METHODS This study was a post hoc analysis of the Patent ductus arteriosus and Left Atrial Size Evaluation in preterm infants (PLASE) study, which is a prospective cohort study including preterm infants admitted to 34 tertiary neonatal intensive care units in Japan between October 2015 and December 2016. We described the details of the treatment strategy of patent ductus arteriosus (PDA) based on early routine echocardiography. RESULTS In total, 613 preterm infants were included into the analysis. Twenty percent of infants with prophylactic indomethacin were switched to therapeutic cyclooxygenase inhibitor (COX-I) before the completion of the full prophylactic indomethacin course. Therapeutic COX-I was mostly administered based on echocardiographic findings before PDA became symptomatic or hemodynamically significant. Therapeutic COX-I was frequently discontinued after one or two doses before the full course (three doses) was completed. The proportion of infants requiring additional treatment (additional therapeutic COX-I course or surgical PDA closure) after discontinued COX-I courses (<3 doses) compared to infants after completed 3 doses course was significantly lower (after the first therapeutic COX-I course 46% vs. 68%, p < 0.001) or without a significant difference (after the second or third course). CONCLUSIONS The clinical management of PDA in Japan featured (1) COX-I administration based on echocardiographic findings before symptomatic or hemodynamically significant PDA appeared and (2) frequent discontinuation of therapeutic COX-I before completing the standard three doses course.
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Affiliation(s)
- Seiichi Tomotaki
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tetsuya Isayama
- Department of Neonatology, National Center for Child Health and Development, Setagaya, Japan
| | - Tohru Kobayashi
- Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Setagaya, Japan
| | - Satoshi Masutani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hidenori Kawasaki
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Atsushi Nakayama
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | | | - Katsuaki Toyoshima
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
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Okten EI, Frankl M, Wu S, Gamaty H, Thompson H, Yardley IE. Factors affecting neurodevelopmental outcome following surgical necrotising enterocolitis: a systematic review. Pediatr Surg Int 2024; 40:71. [PMID: 38446238 PMCID: PMC10917837 DOI: 10.1007/s00383-024-05651-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/07/2024]
Abstract
Surgically treated necrotising enterocolitis (sNEC) is associated with significantly worse neurodevelopmental outcomes than that seen in premature infants without NEC. We aim to review the association between factors involved in the surgical treatment of NEC and subsequent neurodevelopmental outcomes to identify potential areas for improvement. The PubMed and Embase databases were interrogated for articles reporting neurodevelopmental outcomes in babies treated surgically for NEC using key terms including: "Infant", "Necrotising enterocolitis", "Surgical", "Neurodevelopmental" and "Outcomes". The search strategy yielded 1170 articles and after applying inclusion and exclusion criteria 22 studies remained and formed the review. A diverse range of neurodevelopmental outcomes were reported. Extreme prematurity and lower birth weight were associated with worse neurodevelopmental outcomes. The use of peritoneal drains and enterostomies were associated with worse outcomes. Modifications to surgical strategies in NEC may improve neurodevelopmental outcomes but the effect of confounding factors remains unclear. Further large scale studies are required to define the optimum strategies for treating NEC surgically and to develop a core outcome set for research into NEC.
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Affiliation(s)
- E I Okten
- GKT School of Medical Education, King's College London, London, UK
| | - M Frankl
- GKT School of Medical Education, King's College London, London, UK.
| | - S Wu
- GKT School of Medical Education, King's College London, London, UK
| | - H Gamaty
- GKT School of Medical Education, King's College London, London, UK
| | - H Thompson
- Department of Paediatric Surgery, Evelina London Children's Hospital, London, UK
| | - I E Yardley
- GKT School of Medical Education, King's College London, London, UK
- Department of Paediatric Surgery, Evelina London Children's Hospital, London, UK
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Nayak SP, Huff KA, Zaniletti I, Ahmad I, DiGeronimo R, Hair A, Kim J, Markel TA, Piazza A, Reber K, Roberts J, Sharma J, Sullivan K, Premkumar MH, Yanowitz T. Cholestasis is associated with a higher rate of complications in both medical and surgical necrotizing enterocolitis. J Perinatol 2024; 44:100-107. [PMID: 37805591 DOI: 10.1038/s41372-023-01787-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To evaluate the relationship between cholestasis and outcomes in medical and surgical necrotizing enterocolitis (NEC). STUDY DESIGN A retrospective analysis of prospectively collected data from 1472 infants with NEC [455 medical (mNEC) and 1017 surgical (sNEC)] from the Children's Hospital Neonatal Database. RESULTS The prevalence of cholestasis was lower in mNEC versus sNEC (38.2% vs 70.1%, p < 0.001). In both groups, cholestasis was associated with lower birth gestational age [mNEC: OR 0.79 (95% CI 0.68-0.92); sNEC: OR 0.86 (95% CI 0.79-0.95)] and increased days of parenteral nutrition [mNEC: OR 1.08 (95% CI 1.04-1.13); sNEC: OR 1.01 (95% CI 1.01-1.02)]. For both groups, the highest direct bilirubin was associated with the composite outcome mortality or length of stay >75th percentile [mNEC: OR 1.21 (95% CI 1.06-1.38); sNEC: OR 1.06 (95% CI 1.03-1.09)]. CONCLUSION Cholestasis with both medical NEC and surgical NEC is associated with adverse patient outcomes including increased mortality or extreme length of stay.
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Affiliation(s)
| | - Katie A Huff
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
| | | | - Irfan Ahmad
- Children's Hospitals Orange County, Orange, CA, USA
| | - Robert DiGeronimo
- University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Amy Hair
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Jae Kim
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Troy A Markel
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
| | | | - Kristina Reber
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | | | | | | | | | - Toby Yanowitz
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Garg PM, Lett K, Ansari MAY, Pittman I, Riddick R, Varshney N, Morris M, Sawaya D, Taylor C, Reddy K, Porcelli P, Hillegass W. Postoperative Outcomes, and Growth and Brain Injury Outcomes in Spontaneous Intestinal Perforation vs Surgical Necrotizing Enterocolitis in Preterm Infants. Indian Pediatr 2023; 60:922-926. [PMID: 37700582 PMCID: PMC10842114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
OBJECTIVE To compare the clinical outcomes in preterm infants following surgical necrotizing enterocolitis (sNEC) and spontaneous intestinal perforation (SIP). METHODS Retro-spective comparison of clinical information in preterm infants with sNEC and SIP admitted between January, 2013 and December 31, 2018. The clinical outcomes were compared in two groups, including postoperative and brain injury detected on brain magnetic resonance imaging (MRI) after clinical and histopathological confirmation of the SIP and the NEC diagnosis. RESULTS 114 infants had sNEC, and 37 had SIP. Infants with SIP had lower median gestational age [25.1 weeks (23.5, 27.1) vs 26.6 (24.4, 31.0), P=0.03], an earlier mean (SD) age of disease onset [10.1 (11.3) days vs 19.6 (17.9); P<0.001] and lower maternal chorioamnionitis on placental pathology [4 (23.5%) vs 22 (68.8%); P=0.007), received more often Penrose drain therapy (54% vs 33%; P=0.03), had less median (IQR) bowel length loss [3.3 cm (1.72, 4.38) vs 21.4 (9.55, 35.3); P=<0.001] and had more often intact ileocecal valve (91.4% vs 65.7%; P=0.006] compared to those with sNEC. In addition, those with sNEC had lower median (IQR) weight z scores at the time of discharge [-1.88 (-2.80, -1.09) vs -1.14 (-2.22, -0.44); P=0.036] than SIP. There were no significant differences in postoperative ileus, duration of parenteral nutrition, surgical morbidity, length of stay, mortality, white matter, and grey matter injury on brain MRI at term equivalent age in preterm infants with SIP and sNEC. CONCLUSION In our cohort, preterm infants with SIP and sNEC did not show significant differences in postoperative morbidity and brain MRI abnormalities at term equivalent age. sNEC had lower discharge weight z scores. Larger prospective studies are needed for confirmation of these findings.
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Affiliation(s)
- Parvesh Mohan Garg
- Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, USA and Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Katheryn Lett
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Md Abu Yusuf Ansari
- Department of Data Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Isabella Pittman
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Robin Riddick
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Neha Varshney
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael Morris
- Department of Pediatric Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - David Sawaya
- Department of Pediatric Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Charlotte Taylor
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Kartik Reddy
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Peter Porcelli
- Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - William Hillegass
- Department of Data Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA and Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Gao J, Lai D, Tou J. Survey on surgical treatment of neonatal necrotizing enterocolitis in China 2022. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000588. [PMID: 37575368 PMCID: PMC10414103 DOI: 10.1136/wjps-2023-000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Objective The aim of this study was to identify the state of surgical treatment of neonatal necrotizing enterocolitis (NEC) in China. Methods A total of 246 delegates (88.0% senior surgeons) completed a survey sent by the Neonatal Surgery Group of the Pediatric Surgery Branch of the Chinese Medical Association in 2022. Five centers were eliminated due to lack of experience. Results Generally, 38.2% of surgeons work in centers where more than 20 cases of surgical NEC are treated per year. A total of 81.3% of surgeons reported the use of ultrasonography; the most used biomarkers were white blood cell count (95.9%), C-reactive protein (93.8%), and procalcitonin (76.3%). Most surgeons (80.9%) used a combination of two (67.2%) antibiotics or single (29.5%) antibiotic for a treatment period of 7-14 days, and most used antibiotics were carbapenems (73.9%), penicillin and cephalosporins (56.0%). Patients are issued the fasting order for 5-7 days by nearly half surgeons (49.8%) for conservative treatment. 70.1% of surgeons deemed that the most difficult decision was to evaluate the optimal timing of surgery. Most surgeons (76.3%) performed diagnostic aspiration of peritoneal fluid. Laparoscopy was performed for the diagnosis and/or treatment of NEC by 40.2% of surgeons. A total of 53.5% of surgeons reported being able to identify localized intestinal necrosis preoperatively. Surgeons relied the most on pneumoperitoneum (94.2%) and failure of conservative treatment (88.8%) to evaluate the surgical indications. At laparotomy, surgical treatments vary according to NEC severity. Infants are fasted for 5-7 days by 55.2% of surgeons postoperatively. Most surgeons (91.7%) followed up with patients with NEC after discharge for up to 5 years (53.8%). Conclusions The most difficult aspect of surgical NEC is evaluating the timing of surgery, and surgeons in the children's specialized hospitals are experienced. The treatment of NEC totalis is controversial, and the indications for laparoscopy need to be further clarified. More multicenter prospective studies are needed to develop surgical guidelines in the future.
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Affiliation(s)
- Jiafang Gao
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dengming Lai
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Neonatal Surgery Group of the Pediatric Surgery Branch, Chinese Medical Association, Beijing, China
| | - Jinfa Tou
- Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Neonatal Surgery Group of the Pediatric Surgery Branch, Chinese Medical Association, Beijing, China
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Mackay S, Frazer LC, Bailey GK, Miller CM, Gong Q, Dewitt ON, Singh DK, Good M. Identification of serum biomarkers for necrotizing enterocolitis using aptamer-based proteomics. Front Pediatr 2023; 11:1184940. [PMID: 37325361 PMCID: PMC10264655 DOI: 10.3389/fped.2023.1184940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Necrotizing enterocolitis (NEC) is a potentially fatal intestinal disease primarily affecting preterm infants. Early diagnosis of neonates with NEC is crucial to improving outcomes; however, traditional diagnostic tools remain inadequate. Biomarkers represent an opportunity to improve the speed and accuracy of diagnosis, but they are not routinely used in clinical practice. Methods In this study, we utilized an aptamer-based proteomic discovery assay to identify new serum biomarkers of NEC. We compared levels of serum proteins in neonates with and without NEC and identified ten differentially expressed serum proteins between these groups. Results We detected two proteins, C-C motif chemokine ligand 16 (CCL16) and immunoglobulin heavy constant alpha 1 and 2 heterodimer (IGHA1 IGHA2), that were significantly increased during NEC and eight that were significantly decreased. Generation of receiver operating characteristic (ROC) curves revealed that alpha-fetoprotein (AUC = 0.926), glucagon (AUC = 0.860), and IGHA1 IGHA2 (AUC = 0.826) were the proteins that best differentiated patients with and without NEC. Discussion These findings indicate that further investigation into these serum proteins as a biomarker for NEC is warranted. In the future, laboratory tests incorporating these differentially expressed proteins may improve the ability of clinicians to diagnose infants with NEC rapidly and accurately.
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Affiliation(s)
- Stephen Mackay
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill, NC, United States
| | - Lauren C. Frazer
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill, NC, United States
| | - Grace K. Bailey
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill, NC, United States
| | - Claire M. Miller
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill, NC, United States
| | - Qingqing Gong
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Olivia N. Dewitt
- Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Dhirendra K. Singh
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill, NC, United States
| | - Misty Good
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill, NC, United States
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Olaloye O, Eke C, Jolteus A, Konnikova L. Single cell analysis via mass cytometry of spontaneous intestinal perforation reveals alterations in small intestinal innate and adaptive mucosal immunity. Front Immunol 2023; 14:995558. [PMID: 36825028 PMCID: PMC9941693 DOI: 10.3389/fimmu.2023.995558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/18/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction Spontaneous intestinal perforation (SIP) is a poorly understood severe gastrointestinal complications of prematurity which is poorly understood. Extremely premature infants born prior to 28 weeks' gestation develop a localized perforation of the terminal ileum during the first week of life and therapy involves surgery and cessation of enteral feeds. Little is known regardj g the impact of mucosal immune dysfunction on disease pathogenesis. Methods We performed mass cytometry time of flight (CyTOF) of small intestinal mucosa of patients with SIP (Gestational age (GA) 24 - 27 weeks, n=8) compared to patients who had surgery for non-SIP conditions (neonatal (GA >36 weeks, n=5 ) and fetal intestine from elective terminations (GA 18-21 weeks, n=4). CyTOF analysis after stimulation of T cells with PMA/Ionomycin was also performed. Results We noted changes in innate and adaptive mucosal immunity in SIP. SIP mucosa had an expansion of ckit+ neutrophils, an influx of naïve CD4 and CD8 T cells and a reduction of effector memory T cells. SIP T cells were characterized by reduced CCR6 and CXCR3 expression and increased interferon gamma expression after stimulation. Discussion These findings suggest that previously unrecognized immune dysregulation is associated with SIP and should be explored in future studies.
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Affiliation(s)
- Oluwabunmi Olaloye
- Department of Pediatrics, Yale University, New Haven, CT, United States
- Division of Neonatal and Perinatal Medicine Yale University, New Haven, CT, United States
| | - Chino Eke
- Department of Pediatrics, Yale University, New Haven, CT, United States
| | - Abigail Jolteus
- Department of Pediatrics, Yale University, New Haven, CT, United States
| | - Liza Konnikova
- Department of Pediatrics, Yale University, New Haven, CT, United States
- Division of Neonatal and Perinatal Medicine Yale University, New Haven, CT, United States
- Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, CT, United States
- Program in Human and Translational Immunology, Yale University, New Haven, CT, United States
- *Correspondence: Liza Konnikova,
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