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Necrotizing enterocolitis in preterm infant

Sonja C Sawh, Santosh Deshpande, Sandy Jansen, Christopher J Reynaert, Philip M Jones
CONTEXT: Necrotizing enterocolitis (NEC) is the most frequent gastrointestinal emergency in neonates. The microbiome of the preterm gut may regulate the integrity of the intestinal mucosa. Probiotics may positively contribute to mucosal integrity, potentially reducing the risk of NEC in neonates. OBJECTIVE: To perform an updated systematic review and meta-analysis on the efficacy and safety of probiotics for the prevention of NEC in premature infants. DATA SOURCES: Structured searches were performed in: Medline, Embase, and the Cochrane Central Register of Controlled Trials (all via Ovid, from 2013 to January 2015)...
2016: PeerJ
Stephanie Prescott, Jessica Keim-Malpass
BACKGROUND: The incidence of hemodynamically significant patent ductus arteriosus (hsPDA) increases with decreasing gestational age and is associated with many common morbidities of extreme prematurity. Controversies remain surrounding the definition of hsPDA, the population of infants requiring treatment, the appropriate timing and method of treatment, and the outcomes associated with PDA and its therapies. PURPOSE: This integrative literature review focuses on diagnostic and treatment recommendations derived from the highest levels of evidence...
October 8, 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Manuela Molinaro, Massimo Aiazzi, Antonio La Torre, Elisabetta Cini, Roberto Banfi
Preterm infants are at high risk of neonatal sepsis. We report a case of a preterm infant under prophylaxis with Lactobacillus Rhamnosus for necrotizing enterocolitis; the child develops neonatal sepsis by Lactobacillus Rhamnosus. The infection is improved after probiotic withdrawal and had complete remission after 20 days of specific antibiotic therapy.
September 2016: Recenti Progressi in Medicina
Sanjay Chawla, Girija Natarajan, Seetha Shankaran, Athina Pappas, Barbara J Stoll, Waldemar A Carlo, Shampa Saha, Abhik Das, Abbot R Laptook, Rosemary D Higgins
Importance: Many premature infants are born without exposure to antenatal steroids (ANS) or with incomplete courses. This study evaluates the dose-dependent effect of ANS on rates of neonatal morbidities and early childhood neurodevelopmental outcomes of extremely premature infants. Objective: To compare rates of neonatal morbidities and 18- to 22-month neurodevelopmental outcomes of extremely premature infants exposed to no ANS or partial or complete courses of ANS...
October 10, 2016: JAMA Pediatrics
Laura Martínez-Rodríguez, Javier Estañ, Jose D Bermudez, Agustin Molina, Veronica Hortelano, Cecilia Martinez-Costa
No abstract text is available yet for this article.
October 7, 2016: Early Human Development
Crista A Hopp, Ida Sue Baron
OBJECTIVE: Children delivered at the edge of viability are at greatest risk of medical and neuropsychological disability, their adverse outcomes overshadowing extremely preterm survivors with more optimal outcomes. We aimed to describe an exceptionally early-born extremely preterm (EEEP) preschooler whose neurobiological, familial, and socioeconomic factors likely influenced her unexpected cognitive resilience. METHOD: Baby G was a 3-years 10-months-old, English-speaking, Caucasian, singleton girl born weighing 435 g at 22(5/7) weeks' gestation to well-educated married parents...
October 5, 2016: Clinical Neuropsychologist
Steven De Keukeleire, Daniëlle Borrey, Wim Decaluwe, Marijke Reynders
Necrotizing enterocolitis (NEC) continues to be a major cause of neonatal morbidity and mortality. We describe the added value of therapeutic drug monitoring by presenting the case of a preterm infant with severe NEC treated with meropenem. Dosing strategy will achieve adequate patient outcome when treating pathogens with elevated MIC. As safe as meropenem is, there are not enough data for 40 mg/kg, every 8 h infused over 4 h; accordingly, strict monitoring of blood levels is mandatory. Based on our findings, a 4 h prolonged infusion of 40 mg/kg meropenem, every 8 h, will achieve an adequate patient outcome...
2016: Case Reports in Infectious Diseases
Bo Yang, Xiangyu Gao, Yi Ren, Yun Wang, Qinglin Zhang
The aim of the present study was to analyze the changes of plasma and urinary prostaglandin E2 (PGE2) levels in preterm infants with symptomatic patent ductus arteriosus (sPDA) treated with oral ibuprofen and acetaminophen. A total of 87 preterm infants with sPDA admitted to the Neonatal Ward of the Affiliated Xuzhou Hospital of Medical College of Southeast University from October, 2012 to June, 2015 were selected and randomly divided into the ibuprofen group (n=43, 10 mg/kg ibuprofen administered orally as initial dose, followed by 5 mg/kg during the first 24 and 48 h later) and acetaminophen group (n=44, 15 mg/kg acetaminophen administered orally once every 6 h for three days)...
October 2016: Experimental and Therapeutic Medicine
Peymaneh Alizadeh Taheri, Negar Sajjadian, Marzieh Asgharyan Fargi, Mamak Shariat
OBJECTIVE: Breast feeding alone does not provide adequate nutrition for growth in preterm infants; therefore, fortifiers are added when over 70-80 cc/kg/day of breast milk is tolerated. As there are few studies comparing early and late breast milk fortification, the following study was conducted. STUDY DESIGN: This double-blind clinical trial was performed on 80 preterm infants (gestational age of 28-34 weeks, birth weight <2 kg). The newborns were randomly divided into two groups to receive either early or late fortification...
September 27, 2016: Journal of Perinatal Medicine
Tanjina Chowdhury, Muhammad Manajjir Ali, Muhammad Monir Hossain, Jugindra Singh, Abu Noyeem Muhammad Yousuf, Fatema Yasmin, Fazle Rabbi Chowdhury
OBJECTIVE: To evaluate the efficacy of orally administered probiotics in preventing necrotizing enterocolitis (NEC) in preterm very low birth weight (VLBW) infants. STUDY DESIGN: Arandomized double blind controlled trial. PLACE AND DURATION OF STUDY: The Paediatrics Department of Sylhet M.A.G. Osmani Medical College Hospital, Sylhet Bangladesh, from July 2012 to June 2015. METHODOLOGY: Preterm (28 - 33 weeks gestation) VLBW (birth weight 1000 - 1499 g) neonates were enrolled...
September 2016: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Armend Lokku, Lucia Mirea, Shoo K Lee, Prakeshkumar S Shah
Objective To assess trends in patent ductus arteriosus (PDA) management and examine concurrent changes in neonatal mortality and morbidities. Methods This retrospective observational study examined infants born at 23 to 32 weeks' gestational age with PDA and admitted to a neonatal unit during 2006 to 2012. Multivariable logistic regression assessed trends in yearly PDA treatment rates and compared a composite outcome of mortality or any severe morbidity (bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, or necrotizing enterocolitis) between and within time periods and PDA treatments...
September 20, 2016: American Journal of Perinatology
Kathene C Johnson-Henry, Thomas R Abrahamsson, Richard You Wu, Philip M Sherman
Necrotizing enterocolitis (NEC) is a devastating intestinal disease in preterm infants characterized by barrier disruption, intestinal microbial dysbiosis, and persistent inflammation of the colon, which results in high mortality rates. Current strategies used to manage this disease are not sufficient, although the use of human breast milk reduces the risk of NEC. Mother's milk is regarded as a fundamental nutritional source for neonates, but pasteurization of donor breast milk affects the composition of bioactive compounds...
September 2016: Advances in Nutrition
Pia Lundgren, Linnea Lundberg, Gunnel Hellgren, Gerd Holmström, Anna-Lena Hård, Lois E Smith, Agneta Wallin, Boubou Hallberg, Ann Hellström
BACKGROUND: The most severe form of rapidly progressing retinopathy of prematurity (ROP) is termed aggressive posterior ROP (APROP). APROP frequently causes severe visual impairment in affected preterm infants despite timely and appropriate laser treatment. OBJECTIVES: We investigated the postnatal characteristics associated with APROP development in a national Swedish cohort. METHODS: This retrospective, 1:1 matched case-control study included all infants that developed APROP in zone 1 (n = 9) between 2008 and 2012...
September 16, 2016: Neonatology
Ann Hellström, David Ley, Ingrid Hansen-Pupp, Boubou Hallberg, Luca A Ramenghi, Chatarina Löfqvist, Lois E H Smith, Anna-Lena Hård
The neonatal period of very preterm infants is often characterized by a difficult adjustment to extrauterine life, with an inadequate nutrient supply and insufficient levels of growth factors, resulting in poor growth and a high morbidity rate. Long-term multisystem complications include cognitive, behavioral, and motor dysfunction as a result of brain damage as well as visual and hearing deficits and metabolic disorders that persist into adulthood. Insulinlike growth factor 1 (IGF-1) is a major regulator of fetal growth and development of most organs especially the central nervous system including the retina...
September 2016: American Journal of Perinatology
William W Hay, Kendra C Hendrickson
Whereas human milk is the recommended diet for all infants, preterm formulas are indicated for enteral feeding of preterm very low birth weight infants when sufficient maternal breast milk and donor human milk are not available. Feeding with preterm formulas helps to ensure consistent delivery of nutrients. The balance of risks and benefits of feeding preterm formulas versus supplemented maternal and donor breast milk for preterm infants, however, is uncertain. Numerous studies and extensive practice have shown improved growth with preterm formulas, but there is concern for increased risks of necrotizing enterocolitis, possibly from cow milk antigen in the formulas or from different gut microbiomes, increased duration of total parenteral nutrition, and increased rates of sepsis in infants receiving preterm formulas...
August 30, 2016: Seminars in Fetal & Neonatal Medicine
Anthony R Mawson
Neither the mechanisms of parturition nor the pathogenesis of preterm birth are well understood. Poor nutritional status has been suspected as a major causal factor, since vitamin A concentrations are low in preterm infants. However, even large enteral doses of vitamin A from birth fail to increase plasma concentrations of vitamin A or improve outcomes in preterm and/or extremely low birthweight infants. These findings suggest an underlying impairment in the secretion of vitamin A from the liver, where about 80% of the vitamin is stored...
2016: Journal of Translational Science
Deepak Sharma, Sweta Shastri, Pradeep Sharma
BACKGROUND: Lactoferrin (LF) is present in breast milk and have numerous properties including antimicrobial, antiviral, anti-fungal, and anti-cancer. Recent studies have emphasized the role of LF in neonatal care Aims and objective: To evaluate the various roles of Lactoferrin in Neonatal care in preterm infants. SEARCH METHODS: The literature search was done for this systematic review by searching the electronic data base namely Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Web of Science, Scopus, Index Copernicus, African Index Medicus (AIM), Thomson Reuters (ESCI), Chemical Abstracts Service (CAS), SCIWIN (Scientific World Index), Google Scholar, Latin American and Caribbean Health Sciences Information System (LILACS), Index Medicus for the Eastern Mediterranean Region (IMEMR), Index Medicus for the South-East Asian Region (IMSEAR), Western Pacific Region Index Medicus (WPRIM), various sites for ongoing trials namely clinical trial registry ( www...
September 4, 2016: Journal of Maternal-fetal & Neonatal Medicine
Paula G Radmacher, David H Adamkin
Human milk is the preferred feeding for all infants, including those of very low birth weight (<1500 g). It has both nutritional and anti-infective properties which are especially important for infants at risk for sepsis and necrotizing enterocolitis. When maternal milk is not available or the amount produced is not sufficient to meet daily needs, donor human milk may (should) be used in its place. However, donor human milk is generally term in quality and likely has insufficient protein to promote appropriate growth...
September 1, 2016: Seminars in Fetal & Neonatal Medicine
Tamara R Dietze, F F Rose, T A Moore
OBJECTIVE: Complications of prematurity may be related to dysregulation of the hypothalamic-pituitary-adrenal axis in preterm infants. Increased intrauterine exposure to cortisol may be responsible for adverse prenatal programming and subsequent dysfunction of the infant's hypothalamic-pituitary-adrenal axis. The aim of the study was to describe maternal social variables and their association with infant cortisol levels and complications of prematurity. METHODS: Preterm infants <32 weeks' gestation were recruited...
September 16, 2016: Journal of Neonatal-perinatal Medicine
M J Mϋller, T Paul, S Seeliger
Necrotizing enterocolitis (NEC) is the most common acquired disease of the gastrointestinal tract (GIT) in premature infants and newborns. It is defined as an ulcerative inflammation of the intestinal wall. The clinical signs of incipient NEC are often very discrete, and range from localized intestinal symptoms to generalized signs of sepsis. NEC is classified depending on its severity into disease states according to the modified Bell's Classification. Treatment of NEC ranges, depending on its severity, from a conservative therapeutic approach to surgery with resection of the affected parts of the intestine...
September 16, 2016: Journal of Neonatal-perinatal Medicine
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