Family care reduces the incidence of neonatal sepsis: A systematic review and meta-analysis.

Purpose: Family-involved care in the neonatal intensive care unit (NICU) helps to alleviate neonatal anxiety and promotes breastmilk intake, body growth and neurological development, but its effect on reducing the incidence of neonatal sepsis is not known. We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) to evaluate whether neonates receiving family care have a lower incidence of neonatal sepsis compared to neonates receiving standard NICU care. Methods: MEDLINE, Embase, Web of Science, and CENTRAL were searched for RCTs that compared preterm neonates receiving family care vs. standard NICU care. From 126 articles that were identified and screened, 34 full-text articles were assessed for eligibility, and 5 RCTs were included. The primary outcome was the development of sepsis. The RevMan 5.4 software was used to conduct the Meta-analysis. Results: The metanalysis, based on 5 RCTs demonstrated that neonates receiving family-involved care had significantly lower incidence of sepsis (12.0% vs. 16.3%), increased body weight, and reduced length of hospital stay compared to those receiving standard NICU care. Conclusion: This study suggests that family-involved care in NICU can (i) reduce the incidence of neonatal sepsis, (ii) improve growth, and (iii) reduce the length of hospital stay. This study highlights the need for evaluating whether family-involved care improves other neonatal outcomes.

Early antibiotics and risk for necrotizing enterocolitis in premature infants: A narrative review.

While prompt initiation of antibiotics at birth due to concerns for early onset sepsis is common, it often leads to many preterm infants being exposed to treatment despite negative blood cultures. Such exposure to early antibiotics can impact the developing gut microbiome putting infants at increased risk of several diseases. Necrotizing enterocolitis (NEC), a devastating inflammatory bowel disease that affects preterm infants, is among the most widely studied neonatal disease that has been linked to early antibiotics. While some studies have demonstrated an increased risk of NEC, other studies have demonstrated seemingly contrary findings of decreased NEC with early antibiotics. Studies using animal models have also yielded differing findings of benefit vs. harm of early antibiotic exposure on subsequent NEC susceptibility. We thus sought to conduct this narrative review to help clarify the relationship between early antibiotics exposure and future risk of NEC in preterm infants. Our objectives are to: (1) summarize findings from human and animal studies that investigated the relationship between early antibiotics and NEC, (2) highlight important limitations of these studies, (3) explore potential mechanisms that can explain why early antibiotics may increase or decrease NEC risk, and (4) identify future directions for research.

Gestational Age-Specific Complete Blood Count Signatures in Necrotizing Enterocolitis.

Objective: Necrotizing enterocolitis (NEC) is characterized by peripheral cell abnormalities, yet few studies have analyzed the complete blood count (CBC) specifically by gestational age (GA). Our objective was to describe GA-specific immune abnormalities in NEC through a comprehensive analysis of the CBC differential. Methods: Using a cohort of 246 infants (177 cases, 69 controls) admitted to neonatal intensive care units at a single institution, we retrospectively analyzed CBCs around illness onset in NEC cases compared with controls. Cases included surgical NEC (S-NEC, 34.5%) and medical NEC (M-NEC, 65.5%). Infants were divided into those born at GA <33 and ≥33 weeks. Differences in CBC values were described as absolute and percent changes at NEC onset from baseline and at antibiotic completion after NEC. We used machine learning algorithms based on the CBC at NEC to generate predictive models for diagnosis. Results: At NEC onset, there was an acute drop in monocytes and lymphocytes along with a rise in bands in S-NEC infants born <33 weeks compared with M-NEC. In comparison, both M-NEC and S-NEC ≥33 weeks had a percent drop in neutrophils at diagnosis compared with controls. At antibiotic completion, monocytes in S-NEC <33 weeks significantly rose compared with M-NEC, yet for S-NEC ≥33 weeks, bands significantly dropped compared with M-NEC. Predictive modeling was able to accurately predict S-NEC from M-NEC and controls. Conclusion: There are discrete leukocyte patterns in NEC based on GA. The CBC at diagnosis may be useful in identifying patients who will require surgery.

Inborn Errors of Immunity in the Premature Infant: Challenges in Recognition and Diagnosis.

Due to heightened awareness and advanced genetic tools, inborn errors of immunity (IEI) are increasingly recognized in children. However, diagnosing of IEI in premature infants is challenging and, subsequently, reports of IEI in premature infants remain rare. This review focuses on how common disorders of prematurity, such as sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia, can clinically overlap with presenting signs of IEI. We present four recent cases from a single neonatal intensive care unit that highlight diagnostic dilemmas facing neonatologists and clinical immunologists when considering IEI in preterm infants. Finally, we present a conceptual framework for when to consider IEI in premature infants and a guide to initial workup of premature infants suspected of having IEI.

Enterocolitis necrotizante: hallazgos sociodemográficos, clínicos e histopatológicos en una serie de autopsias neonatales / Necrotizing entercolitis: socio-demographic, clinical and histopathological findings in a series of neonatal autopsies / Enterocolite necrosante: achados sociodemográficos, clínicos e histopatológicos em uma série de autópsias neonatais

Introducción. La enterocolitis necrotizante es un trastorno caracterizado por la necrosis isquémica de la mucosa intestinal, es la enfermedad gastrointestinal más grave que afecta a los neonatos, con alta morbilidad y mortalidad, principalmente en prematuros. El objetivo del presente estudio es describir las características clínicas y anatomopatológicas de los recién nacidos fallecidos con enterocolitis necrotizante, diagnosticados en un hospital de alta complejidad. Metodología. Este es un estudio descriptivo retrospectivo de 21 casos de autopsias médico-científicas hechas en un hospital de alta complejidad del nororiente colombiano, con hallazgos anatomopatológicos de enterocolitis necrotizante, realizadas entre enero de 2013 y julio de 2017. Resultados. El 85.7% de los recién nacidos eran pretérminos, un igual porcentaje presentaba un peso menor a 2,500 gramos al nacer. Respecto a los antecedentes maternos el 14.3% tuvieron espectro de trastornos hipertensivos asociados al embarazo y el 23.8% infección materna. Los tres sitios más frecuentes de ubicación de enterocolitis necrotizantes fue íleon, colon ascendente y colon transverso. Discusión. Según algunos autores, hasta el 85% de todos los casos de enterocolitis necrotizante ocurren en pacientes prematuros, especialmente en bebés con peso extremadamente bajo al nacer. Hay formas de enterocolitis necrotizante que ocurren en bebés a término y, generalmente, están asociadas con factores predisponentes, resultados compatibles con lo que encontramos en esta investigación. Conclusiones. Este estudio elaborado con población colombiana se correlaciona con lo descrito en la población mundial en la cual la enterocolitis necrotizante se presenta más en los recién nacidos pretérmino y con bajo peso al nacer. Cómo citar. Sandoval-Martínez DK, Jaimes-Sanabria MZ, Jiménez-Vargas FL, Chaparro-Zaraza DF, Manrique-Hernández EF. Enterocolitis necrotizante: hallazgos sociodemográficos, clínicos e histopatológicos en una serie de autopsias neonatales. MedUNAB. 2020;23(1):35-42. Doi: 10.29375/01237047.3682

Introduction. Necrotizing entercolitis is a disorder characterized by the ischemic necrosis of intestinal mucosa. It is the most serious gastrointestinal disease affecting neonates, with high morbidity and mortality rates, mainly among premature newborns. The purpose of this study is to describe the clinical and anatamo-pathological characteristics of deceased newborns with necrotizing entercolitis, diagnosed at a high-complexity hospital. Methodology. This is a descriptive retrospective study of 21 cases of medical-scientific autopsies performed at a high-complexity hospital in northeastern Colombia, with anatomo-pathological findings of necrotizing entercolitis, performed between January 2013 and July 2017. Results. 85.7% of the newborns were pre-term, and the same percentage had weight at birth below 2.5 kilograms. Regarding the mothers' background, 14.3% displayed a spectrum of hypertensive disorders associated with pregnancy, and 23.8% had maternal infections. The three most frequent locations of necrotizing entercolitis were the ileum, ascending colon and transverse colon. Discussion. According to some authors, up to 85% of all cases of necrotizing entercolitis occur in premature patients, especially in babies with extremely low weight at birth. There are forms of necrotizing entercolitis that occur in full term babies, and they are generally associated with contributing factors, which is consistent with the findings of this study. Conclusions. This study of a Colombian population is consistent with other descriptions of the global population, where necrotizing entercolitis arises more frequently in pre-term newborns and low weight at birth. Cómo citar. Sandoval-Martínez DK, Jaimes-Sanabria MZ, Jiménez-Vargas FL, Chaparro-Zaraza DF, Manrique-Hernández EF. Enterocolitis necrotizante: hallazgos sociodemográficos, clínicos e histopatológicos en una serie de autopsias neonatales. MedUNAB. 2020;23(1):35-42. Doi: 10.29375/01237047.3682

Introdução. A enterocolite necrosante é um transtorno caracterizado por necrose isquêmica da mucosa intestinal é a doença gastrointestinal mais grave que afeta aos recém-nascidos, com alta morbimortalidade, principalmente em prematuros. O objetivo deste estudo é descrever as características clínicas e anatomopatológicas dos recém-nascidos que morreram com enterocolite necrosante, diagnosticados em um hospital de alta complexidade. Métodos. Este é um estudo descritivo retrospectivo de 21 casos de autópsias médico-científicas feitas em um hospital de alta complexidade no nordeste da Colômbia, com achados anatomopatológicos de enterocolite necrosante, realizadas entre janeiro de 2013 e julho de 2017. Resultados. 85.7% dos recém-nascidos eram prematuros. Uma porcentagem igual tinha um peso menor que 2,500 gramas ao nascer. Em relação à história materna, 14.3% possuíam espectro de transtornos hipertensivos associados à gravidez e 23.8% à infecção materna. Os três locais mais frequentes de enterocolite necrosantes foram íleo, colo ascendente e colo transverso. Discussão. Segundo alguns autores, até 85% de todos os casos de enterocolite necrosante ocorrem em prematuros, Introdução. A enterocolite necrosante é um transtorno caracterizado por necrose isquêmica da mucosa intestinal é a doença gastrointestinal mais grave que afeta aos recém-nascidos, com alta morbimortalidade, principalmente em prematuros. O objetivo deste estudo é descrever as características clínicas e anatomopatológicas dos recém-nascidos que morreram com enterocolite necrosante, diagnosticados em um hospital de alta complexidade. Métodos. Este é um estudo descritivo retrospectivo de 21 casos de autópsias médico-científicas feitas em um hospital de alta complexidade no nordeste da Colômbia, com achados anatomopatológicos de enterocolite necrosante, realizadas entre janeiro de 2013 e julho de 2017. Resultados. 85.7% dos recém-nascidos eram prematuros. Uma porcentagem igual tinha um peso menor que 2,500 gramas ao nascer. Em relação à história materna, 14.3% possuíam espectro de transtornos hipertensivos associados à gravidez e 23.8% à infecção materna. Os três locais mais frequentes de enterocolite necrosantes foram íleo, colo ascendente e colo transverso. Discussão. Segundo alguns autores, até 85% de todos os casos de enterocolite necrosante ocorrem em prematuros, principalmente em bebês com peso extremamente baixo ao nascer. Existem formas deenterocolite necrosante que ocorrem em bebês a termo e, geralmente, estão associadas a fatorespredisponentes, resultados compatíveis com os achados nesta pesquisa. Conclusão. Este estudo realizado com população colombiana está correlacionado com o descrito na população mundial em que a enterocolite necrosante ocorre mais nos recém-nascidos prematuros e com baixo peso ao nascer. Cómo citar. Sandoval-Martínez DK, Jaimes-Sanabria MZ, Jiménez-Vargas FL, Chaparro-Zaraza DF, Manrique-Hernández EF. Enterocolitis necrotizante: hallazgos sociodemográficos, clínicos e histopatológicos en una serie de autopsias neonatales. MedUNAB. 2020;23(1):35-42. Doi: 10.29375/01237047.3682

Necrotizing entercolitis: socio-demographic, clinical and histopathological findings in a series of neonatal autopsies / Enterocolitis necrotizante: hallazgos sociodemográficos, clínicos e histopatológicos en una serie de autopsias neonatales / Enterocolite necrosante: achados sociodemográficos, clínicos e histopatológicos em uma série de autópsias neonatais

Introduction. Necrotizing entercolitis is a disorder characterized by the ischemic necrosis of intestinal mucosa. It is the most serious gastrointestinal disease affecting neonates, with high morbidity and mortality rates, mainly among premature newborns. The purpose of this study is to describe the clinical and anatamo-pathological characteristics of deceased newborns with necrotizing entercolitis, diagnosed at a high-complexity hospital. Methodology. This is a descriptive retrospective study of 21 cases of medical-scientific autopsies performed at a high-complexity hospital in northeastern Colombia, with anatomo-pathological findings of necrotizing entercolitis, performed between January 2013 and July 2017. Results. 85.7% of the newborns were pre-term, and the same percentage had weight at birth below 2.5 kilograms. Regarding the mothers' background, 14.3% displayed a spectrum of hypertensive disorders associated with pregnancy, and 23.8% had maternal infections. The three most frequent locations of necrotizing entercolitis were the ileum, ascending colon and transverse colon. Discussion. According to some authors, up to 85% of all cases of necrotizing entercolitis occur in premature patients, especially in babies with extremely low weight at birth. There are forms of necrotizing entercolitis that occur in full term babies, and they are generally associated with contributing factors, which is consistent with the findings of this study. Conclusions. This study of a Colombian population is consistent with other descriptions of the global population, where necrotizing entercolitis arises more frequently in pre-term newborns and low weight at birth. Cómo citar. Sandoval-Martínez DK, Jaimes-Sanabria MZ, Jiménez-Vargas FL, Chaparro-Zaraza DF, Manrique-Hernández EF. Enterocolitis necrotizante: hallazgos sociodemográficos, clínicos e histopatológicos en una serie de autopsias neonatales. MedUNAB. 2020;23(1):35-42. Doi: 10.29375/01237047.3682

Introducción. La enterocolitis necrotizante es un trastorno caracterizado por la necrosis isquémica de la mucosa intestinal, es la enfermedad gastrointestinal más grave que afecta a los neonatos, con alta morbilidad y mortalidad, principalmente en prematuros. El objetivo del presente estudio es describir las características clínicas y anatomopatológicas de los recién nacidos fallecidos con enterocolitis necrotizante, diagnosticados en un hospital de alta complejidad. Metodología. Este es un estudio descriptivo retrospectivo de 21 casos de autopsias médico-científicas hechas en un hospital de alta complejidad del nororiente colombiano, con hallazgos anatomopatológicos de enterocolitis necrotizante, realizadas entre enero de 2013 y julio de 2017. Resultados. El 85.7% de los recién nacidos eran pretérminos, un igual porcentaje presentaba un peso menor a 2,500 gramos al nacer. Respecto a los antecedentes maternos el 14.3% tuvieron espectro de trastornos hipertensivos asociados al embarazo y el 23.8% infección materna. Los tres sitios más frecuentes de ubicación de enterocolitis necrotizantes fue íleon, colon ascendente y colon transverso. Discusión. Según algunos autores, hasta el 85% de todos los casos de enterocolitis necrotizante ocurren en pacientes prematuros, especialmente en bebés con peso extremadamente bajo al nacer. Hay formas de enterocolitis necrotizante que ocurren en bebés a término y, generalmente, están asociadas con factores predisponentes, resultados compatibles con lo que encontramos en esta investigación. Conclusiones. Este estudio elaborado con población colombiana se correlaciona con lo descrito en la población mundial en la cual la enterocolitis necrotizante se presenta más en los recién nacidos pretérmino y con bajo peso al nacer. Cómo citar. Sandoval-Martínez DK, Jaimes-Sanabria MZ, Jiménez-Vargas FL, Chaparro-Zaraza DF, Manrique-Hernández EF. Enterocolitis necrotizante: hallazgos sociodemográficos, clínicos e histopatológicos en una serie de autopsias neonatales. MedUNAB. 2020;23(1):35-42. Doi: 10.29375/01237047.3682

Introdução. A enterocolite necrosante é um transtorno caracterizado por necrose isquêmica da mucosa intestinal é a doença gastrointestinal mais grave que afeta aos recém-nascidos, com alta morbimortalidade, principalmente em prematuros. O objetivo deste estudo é descrever as características clínicas e anatomopatológicas dos recém-nascidos que morreram com enterocolite necrosante, diagnosticados em um hospital de alta complexidade. Métodos. Este é um estudo descritivo retrospectivo de 21 casos de autópsias médico-científicas feitas em um hospital de alta complexidade no nordeste da Colômbia, com achados anatomopatológicos de enterocolite necrosante, realizadas entre janeiro de 2013 e julho de 2017. Resultados. 85.7% dos recém-nascidos eram prematuros. Uma porcentagem igual tinha um peso menor que 2,500 gramas ao nascer. Em relação à história materna, 14.3% possuíam espectro de transtornos hipertensivos associados à gravidez e 23.8% à infecção materna. Os três locais mais frequentes de enterocolite necrosantes foram íleo, colo ascendente e colo transverso. Discussão. Segundo alguns autores, até 85% de todos os casos de enterocolite necrosante ocorrem em prematuros, Introdução. A enterocolite necrosante é um transtorno caracterizado por necrose isquêmica da mucosa intestinal é a doença gastrointestinal mais grave que afeta aos recém-nascidos, com alta morbimortalidade, principalmente em prematuros. O objetivo deste estudo é descrever as características clínicas e anatomopatológicas dos recém-nascidos que morreram com enterocolite necrosante, diagnosticados em um hospital de alta complexidade. Métodos. Este é um estudo descritivo retrospectivo de 21 casos de autópsias médico-científicas feitas em um hospital de alta complexidade no nordeste da Colômbia, com achados anatomopatológicos de enterocolite necrosante, realizadas entre janeiro de 2013 e julho de 2017. Resultados. 85.7% dos recém-nascidos eram prematuros. Uma porcentagem igual tinha um peso menor que 2,500 gramas ao nascer. Em relação à história materna, 14.3% possuíam espectro de transtornos hipertensivos associados à gravidez e 23.8% à infecção materna. Os três locais mais frequentes de enterocolite necrosantes foram íleo, colo ascendente e colo transverso. Discussão. Segundo alguns autores, até 85% de todos os casos de enterocolite necrosante ocorrem em prematuros, principalmente em bebês com peso extremamente baixo ao nascer. Existem formas deenterocolite necrosante que ocorrem em bebês a termo e, geralmente, estão associadas a fatorespredisponentes, resultados compatíveis com os achados nesta pesquisa. Conclusão. Este estudo realizado com população colombiana está correlacionado com o descrito na população mundial em que a enterocolite necrosante ocorre mais nos recém-nascidos prematuros e com baixo peso ao nascer. Cómo citar. Sandoval-Martínez DK, Jaimes-Sanabria MZ, Jiménez-Vargas FL, Chaparro-Zaraza DF, Manrique-Hernández EF. Enterocolitis necrotizante: hallazgos sociodemográficos, clínicos e histopatológicos en una serie de autopsias neonatales. MedUNAB. 2020;23(1):35-42. Doi: 10.29375/01237047.3682

The strong correlation between neonatal early-onset Group B Streptococcal disease and necrotizing enterocolitis.

BACKGROUND: Necrotizing enterocolitis (NEC) is a leading cause of newborn gastrointestinal emergencies, affecting 1-3 per 1000 live births. Although NEC has been linked to a microbial etiology, associations with maternal intrapartum and resultant newborn early-onset invasive Group B streptococcus (EO-GBS) have been weakly defined. OBJECTIVE: The study aim was to determine the relationship between EO-GBS and NEC. STUDY DESIGN: Data from 2008 to 2015 were collected from pediatric records with ICD diagnosis codes consistent with all stages of NEC, with the exception of neonatal EO-GBS data (only available 2011-2015). RESULTS: For the 131 newborns meeting inclusion criteria, the mean gestational age (GA) and birthweight at delivery was 30.2 weeks and 1449 g. Maternal comorbidities were not associated with a more advanced stage of NEC, however male gender (OR 3.2, p < .001), lower mean 1 (OR = 0.89, p = .045) and 5 min Apgar scores (OR = 0.84, p = .009) were significantly associated with higher NEC stage, after controlling for GA. Infectious morbidities including chorioamnionitis (OR = 1.5, p = .553) and intrapartum antibiotic administration (OR = 1.3, p = .524) were not significantly associated with higher NEC stage. Neither neonatal sepsis workup (OR = 0.27, p = .060) nor positive blood culture (OR = 0.97, p = .942) prior to NEC diagnosis were statistically significant. Type of feed prior to diagnosis (p = .530) was not significantly associated with NEC stage, however, expressed breast milk tended to be protective against higher stage of NEC (OR = 0.49, p = .055). Type of feed included total parenteral nutrition, mother's or donor expressed breast milk, trophic, full and high calorie feeds. Of the 579 newborns admitted from 2011 to 2015, 13 (2%) were diagnosed with EO-GBS and 64 met diagnostic criteria for NEC. GBS positive newborns had significantly higher odds of NEC (OR = 5.37, p = .009). NEC stage was not significantly different for patients with GBS positive vs. GBS negative mothers (p = .732), nor was there a significant difference in GA (p = .161). CONCLUSION: Our study is the first to describe a strong correlation between neonatal EO- GBS disease and NEC, with more than a five-fold increase in the odds of developing NEC in newborns of GBS positive mothers. PURPOSE: To investigate a possible relationship between EO-GBS disease and the neonatal diagnosis of NEC. Secondary analysis will determine if maternal antepartum and intrapartum factors along with neonatal variables contribute to a more advanced stage of NEC by retrospective chart review of patient data collected at Children's Hospital: New Orleans.

Dysbiosis in the inflamed intestine: chance favors the prepared microbe.

The bacterial microbiota of the human large bowel is a complex ecosystem consisting of several hundred, mostly anaerobic, species. To maintain colonization of the gut lumen and maximize growth in the presence of nutritional competitors, highly diverse metabolic pathways have evolved, with each microbe utilizing a different "winning strategy" for nutrient acquisition and utilization. Conditions and diseases leading to intestinal inflammation are accompanied by a severe disruption the microbiota composition characterized by an expansion of facultative anaerobic Enterobacteriaceae. Here, we review evidence that the local inflammatory response creates a unique nutritional environment that is conducive to a bloom of bacterial species whose genomes encode the capability of utilizing inflammation-derived nutrients.