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Necrotizing enterocolitis

Ufuk Cakir, Cuneyt Tayman, Utku Serkant, Halil Ibrahim Yakut, Esra Cakir, Ufuk Ates, Ismail Koyuncu, Eyyup Karaogul
ETHNOPHARMACOLOGICAL RELEVANCE: Necrotizing enterocolitis (NEC) is the most important gastrointestinal emergency affecting especially preterm infants and causes severe morbidities and mortality. However, there is no cure. Oxidant stress, inflammation, apoptosis, as well as prematurity are believed to responsible in the pathogenesis of the disease. Ginger and its compounds have anti-inflammatory, antimicrobial, anti-oxidant properties and immunomodulatory, cytoprotective/regenerative actions...
July 10, 2018: Journal of Ethnopharmacology
Anna Parra-Llorca, María Gormaz, Cristina Alcántara, María Cernada, Antonio Nuñez-Ramiro, Máximo Vento, Maria C Collado
Preterm microbial colonization is affected by gestational age, antibiotic treatment, type of birth, but also by type of feeding. Breast milk has been acknowledged as the gold standard for human nutrition. In preterm infants breast milk has been associated with improved growth and cognitive development and a reduced risk of necrotizing enterocolitis and late onset sepsis. In the absence of their mother's own milk (MOM), pasteurized donor human milk (DHM) could be the best available alternative due to its similarity to the former...
2018: Frontiers in Microbiology
Daniel J C Berkhout, Patrick Klaassen, Hendrik J Niemarkt, Willem P de Boode, Veerle Cossey, Johannes B van Goudoever, Christiaan V Hulzebos, Peter Andriessen, Anton H van Kaam, Boris W Kramer, Richard A van Lingen, Daniel C Vijlbrief, Mirjam M van Weissenbruch, Marc Benninga, Nanne K H de Boer, Tim G J de Meij
BACKGROUND: The identification of independent clinical risk factors for necrotizing enterocolitis (NEC) may contribute to early selection of infants at risk, allowing for the development of targeted strategies aimed at the prevention of NEC. OBJECTIVE: The objective of this study was to identify independent risk factors contributing to the development of NEC in a large multicenter cohort. METHODS: This prospective cohort study was performed in 9 neonatal intensive care units...
July 11, 2018: Neonatology
Ruchi Amin, Michelle Knezevich, Melissa Lingongo, Aniko Szabo, Ziyan Yin, Keith T Oldham, Casey M Calkins, Thomas T Sato, Marjorie J Arca
OBJECTIVE: This prospective observational study was designed to assess Pediatric Quality of Life (PedsQL) after surgical treatment for congenital diaphragmatic hernia (CDH), esophageal atresia/tracheoesophageal fistula (EA/TEF), Hirschsprung disease (HD), gastroschisis (GAS), omphalocele (OMP), and necrotizing enterocolitis (NEC). SUMMARY OF BACKGROUND DATA: Improvements in neonatal and surgical care have led to increased survival for many newborn conditions. Quality of life in these patients is seldom explored in a longitudinal manner...
July 9, 2018: Annals of Surgery
Jing Sun, Yanqi Li, Xiaoyu Pan, Duc Ninh Nguyen, Anders Brunse, Anders M Bojesen, Silvia Rudloff, Martin S Mortensen, Douglas G Burrin, Per T Sangild
BACKGROUND: Fortification of donor human milk (DHM) is required for optimal growth of very preterm infants, but there are concerns of more gut dysfunction and necrotizing enterocolitis (NEC) when using formula-based fortifiers (FFs), especially soon after birth. Intact bovine colostrum (BC) is rich in nutrients and bioactive factors, and protects against NEC in preterm pigs. We hypothesized that fortification of DHM with BC is superior to FFs to prevent gut dysfunction and infections when provided shortly after preterm birth...
July 10, 2018: JPEN. Journal of Parenteral and Enteral Nutrition
Hyo-Jeong Jang, Jae Hyun Park, Chun Soo Kim, Sang Lak Lee, Won Mok Lee
Purpose: We investigated fecal calprotectin (FC) levels in preterm infants with and without feeding intolerance (FI), and compared the FC levels according to the type of feeding. Methods: The medical records of 67 premature infants were reviewed retrospectively. The fully enteral-fed infants were classified into two groups; the FI group (29 infants) and the control group (31 infants). Seven infants with necrotizing enterocolitis, sepsis, and perinatal asphyxia were excluded...
July 2018: Pediatric Gastroenterology, Hepatology & Nutrition
Isabela Gusson Galdino Dos Santos, Maria Aparecida Mezzacappa, Beatriz Regina Alvares
Objective: The aim of this study was to identify radiological and clinical risk factors for death in newborns with necrotizing enterocolitis. Materials and Methods: This was a retrospective cohort study, based on radiological examinations and medical charts of 66 infants with necrotizing enterocolitis, as confirmed by a finding of intestinal pneumatosis (stage IIA, according to modified Bell's staging criteria). Radiological and clinical variables were evaluated...
May 2018: Radiologia Brasileira
Behnam Sadeghirad, Rebecca L Morgan, Dena Zeraatkar, Adriana M Zea, Rachel Couban, Bradley C Johnston, Ivan D Florez
CONTEXT: Human and bovine colostrum (HBC) administration has been linked to beneficial effects on morbidity and mortality associated with necrotizing enterocolitis (NEC). OBJECTIVES: To determine the effectiveness and safety of HBC for reducing NEC, mortality, sepsis, time to full-feed and feeding intolerance in preterm infants. DATA SOURCES: We conducted searches through Medline, Embase, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, and gray literature...
July 10, 2018: Pediatrics
Colin Martin, Mikita Patel, Sparkle Williams, Hamish Arora, Brian Sims
Human breast milk has been shown to reduce the incidence of necrotizing enterocolitis (NEC). Breast milk has many components (immunoglobulins, proteins, fat, and, of recent interest, exosomes), but the specific component that affords protection against NEC is not known. Exosomes are small-nanometer vesicles that are rich in protein, lipid, and microRNA. Here, we hypothesized that human breast milk-derived exosomes can protect intestinal epithelial cells (IECs) from cell death. Human breast milk was collected, separated using ultracentrifugation, and quantified using NanoSight tracking analysis...
January 1, 2018: Innate Immunity
Daniela Doni, Giuseppe Paterlini, Anna Locatelli, Sara Arnoldi, Maria Chiara Magri, Davide Bernasconi, Maria Grazia Valsecchi, Paolo Emilio Tagliabue
Premature birth is a leading cause of neonatal morbidity and mortality. Since gestational age at birth is the most important predictive factor of adverse neonatal outcomes, strategies to postpone premature labor are of major importance. Studies on tocolytic drugs show that COX inhibitors such as indomethacin are superior to others in terms of efficiency in delaying birth, but results concerning neonatal outcomes associated with prenatal exposure to these drugs show controversial results. Indomethacin is also used in the postnatal age for pharmacologic treatment of patent ductus arteriosus (PDA), but no data concerning the effects of antenatal exposure on postnatal ductal patency are available...
July 9, 2018: Journal of Maternal-fetal & Neonatal Medicine
David J Hackam, Chhinder P Sodhi, Misty Good
BACKGROUND/PURPOSE: Necrotizing enterocolitis (NEC) is a devastating disease of prematurity that develops after feeding, often without warning, and results in diffuse intestinal necrosis leading to sepsis and death in many cases. The lack of improvement in overall survival is influenced by nonspecific diagnostic modalities as well as inexact and nonpersonalized treatment strategies. METHODS/RESULTS: Recently, we and others have shown that NEC develops in response to exaggerated bacterial signaling in the premature intestine, as a consequence of elevated expression and activity of the bacterial receptor toll-like receptor 4 (TLR4), which is important for normal gut development...
June 18, 2018: Journal of Pediatric Surgery
V Núñez Cerezo, M Romo Muñoz, J L Encinas, M Dore Reyes, P Triana Junco, A Vilanova Sánchez, A Sánchez Galán, M Gómez Cervantes, J Jiménez Gómez, M D Elorza Fernández, L Martínez Martínez, M López Santamaría
AIM OF THE STUDY: The aim of this study is to identify potential perinatal risk or protective factors associated with NEC. MATERIALS AND METHODS: Single-center, retrospective case-control study of newborns admitted to the neonatal intensive care unit with NEC from 2014 to 2015. Clinical charts were reviewed recording maternal factors (fever, positive recto-vaginal swab and signs of corioamnionitis or fetal distress), and neonatal factors analyzed were: birth-weight and weeks gestation, umbilical vessel catheterization, time of enteral feedings and the use of probiotics, antibiotics and antifungal agents...
April 20, 2018: Cirugía Pediátrica: Organo Oficial de la Sociedad Española de Cirugía Pediátrica
Girish Deshpande, Gayatri Athalye-Jape, Sanjay Patole
Current evidence supports the use of probiotics in preterm neonates for prevention of necrotizing enterocolitis, mortality and late onset sepsis. Despite the strong evidence, the uptake of this intervention has not been universal due to concerns including probiotic sepsis, pro-inflammatory response and transmission of antibiotic resistance. Critically ill extremely preterm neonates with potentially compromised gut integrity are at higher risk of probiotic sepsis due to translocation. In most countries, probiotics are sold as food supplements with poor quality control...
July 5, 2018: Nutrients
Corinna Gebauer, Daniel Klotz, Skadi Springer
Over the last decades the immense benefit of human milk on the nutrition of preterm infants has become increasingly evident. Research has confirmed that human milk has significant advantages for the preterm infant in terms of host defense, gastrointestinal development and maturation, neurological development, reduction of necrotizing enterocolitis, retinopathy of prematurity and chronic lung disease as well as mental and physical benefits for the mother. Computing these factors into a health-cost-benefit equation, positive economic consequences for a national public health system were demonstrated...
July 3, 2018: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
Martina Persson, Prakesh S Shah, Franca Rusconi, Brian Reichman, Neena Modi, Satoshi Kusuda, Liisa Lehtonen, Stellan Håkansson, Junmin Yang, Tetsuya Isayama, Marc Beltempo, Shoo Lee, Mikael Norman
Importance: Diabetes in pregnancy is associated with a 2-times to 3-times higher rate of very preterm birth than in women without diabetes. Very preterm infants are at high risk of death and severe morbidity. The association of maternal diabetes with these risks is unclear. Objective: To determine the associations between maternal diabetes and in-hospital mortality, as well as neonatal morbidity in very preterm infants with a birth weight of less than 1500 g. Design, Setting, Participants: This retrospective cohort study was conducted at 7 national networks in high-income countries that are part of the International Neonatal Network for Evaluating Outcomes in Neonates and used prospectively collected data on 76 360 very preterm, singleton infants without malformations born between January 1, 2007, and December 31, 2015, at 24 to 31 weeks' gestation with birth weights of less than 1500 g, 3280 (4...
July 2, 2018: JAMA Pediatrics
Neta Berlak, Eilon Shany, Shalom Ben-Shimol, Ilana Azulay Chertok, Gil Goldinger, David Greenberg, Rimma Melamed
OBJECTIVE: To compare demographic and clinical features of neonates with late-onset sepsis due to coagulase-negative-staphylococcus with those due to other bacterial pathogens. STUDY DESIGN: Retrospective, population-based cohort study. Data on infants less than 90 days old diagnosed with late-onset bacterial sepsis in the neonatal intensive care unit were reviewed. Univariable and multivariable analysis were performed. RESULTS: Two hundred and sixteen sepsis episodes were identified: coagulase-negative-staphylococcus caused 113 (52...
July 3, 2018: Infectious Diseases
Yu Han Koh, Rebecca Cooksey, Peter Prager
We report a case of a male, term newborn with known left congenital diaphragmatic hernia (CDH) who presented with circulatory compromise requiring maximal inotropic support in the first 24 hours of life. Repeat X-ray at 24 hours showed pneumatosis intestinalis. Emergency laparotomy was performed for suspected necrotising enterocolitis. The terminal ileum to the sigmoid colon were frankly necrotic with multiple perforations. Subtotal colectomy was performed. Although the recovery was protracted, the baby had a favourable outcome with progressive weight gain on follow-up at 3, 6 and 9 months of age...
June 28, 2018: BMJ Case Reports
Meijia Wang, Judith S Mercer, James F Padbury
We evaluated a subset of infants with suspected intrauterine growth restriction or birth weights small for gestational age enrolled in a study of delayed cord clamping for preterm infants. Compared with immediate clamping, delayed cord clamping was associated with no apparent harm and less suspected necrotizing enterocolitis. TRIAL REGISTRATION: NCT00818220 and NCT01426698.
June 25, 2018: Journal of Pediatrics
Jeff Reese, Theresa A Scott, Stephen W Patrick
Optimal management of patent ductus arteriosus (PDA) is unclear. One treatment, surgical ligation, is associated with adverse outcomes. We reviewed data from the Kids' Inpatient Database (2000-2012) to determine if PDA ligation rates: (1) changed over time, (2) varied geographically, or (3) influenced surgical complication rates. In 2012, 47,900 infants <1500g birth weight were born in the United States, including 2,800 undergoing PDA ligation (5.9%). Ligation was more likely in infants <1000g (85.9% vs...
May 22, 2018: Seminars in Perinatology
Yuhang Yuan, Daokui Ding, Ning Zhang, Ziqiang Xia, Jiaxiang Wang, Heying Yang, Fei Guo, Bing Li
Necrotizing enterocolitis (NEC) is a potentially fatal illness in premature neonates. Tumor necrosis factor-α (TNF-α) and autophagy are associated with the pathogenesis of NEC. This study aimed to explore whether TNF-α might regulate apoptosis in neonatal NEC model cells IEC-6 via regulation of autophagy. NEC rat model was induced by hand feeding and exposure to asphyxia/cold-stress for histologic examination. The NEC in vitro model (IEC-6/NEC cells) was established by stimulating the intestinal epithelial cell line IEC-6 with lipopolysaccharide (LPS, 100 μg/mL) for 3 h to investigate the effects of TNF-α on IEC-6 proliferation and apoptosis...
June 27, 2018: Cell Cycle
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