Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.211
Filtrar
1.
Ital J Pediatr ; 48(1): 6, 2022 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-35012576

RESUMEN

BACKGROUND: Necrotizing enterocolitis (NEC) is a devastating disease in preterm infants with significant morbidities, including neurodevelopmental impairment (NDI). This study aimed to investigate whether NEC is associated with (1) brain volume expansion and white matter maturation using diffusion tensor imaging analysis and (2) NDI compared with preterm infants without NEC. METHODS: We included 86 preterm infants (20 with NEC and 66 without NEC) with no evidence of brain abnormalities on trans-fontanelle ultrasonography and magnetic resonance imaging at term-equivalent age (TEA). Regional brain volume analysis and white matter tractography were performed to study brain microstructure alterations. NDI was assessed using the Bayley Scales of Infant and Toddler Development-III (BSID-III) at 18 months of corrected age (CA). RESULTS: Preterm infants with NEC showed significantly high risk of motor impairment (odds ratio 58.26, 95% confidence interval 7.80-435.12, p < 0.001). We found significantly increased mean diffusivity (MD) in the splenium of corpus callosum (sCC) (p = 0.001) and the left corticospinal tract (p = 0.001) in preterm infants with NEC. The sCC with increased MD showed a negative association with the BSID-III language (p = 0.025) and motor scores (p = 0.002) at 18 months of CA, implying the relevance of sCC integrity with later NDI. CONCLUSION: The white matter microstructure differed between preterm infants with and without NEC. The prognostic value of network parameters of sCC at TEA may provide better information for the early detection of NDI in preterm infants.


Asunto(s)
Cuerpo Calloso/diagnóstico por imagen , Discapacidades del Desarrollo/etiología , Enterocolitis Necrotizante/complicaciones , Enfermedades del Prematuro , Recien Nacido Prematuro , Imagen de Difusión Tensora , Femenino , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Estudios Prospectivos , Tractos Piramidales/diagnóstico por imagen
2.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(11): 1306-1309, 2021 Nov 28.
Artículo en Inglés, Chino | MEDLINE | ID: mdl-34911867

RESUMEN

A male infant, whose weight was 1 120 g at 28+2 weeks of gestational age, was admitted to Neonatal Intensive Care Unit of West China Second Hospital of Sichuan University at 20 min after preterm birth. Blood transfusion was performed for anemia (hemoglobin 81 g/L) on day 30 of hospitalization, and feeding was continued during the transfusion. Eight hours after blood transfusion, the patient's manifestations included abdominal distension and stiff to palpation, bowel sound weakening, currant jelly stool, poor responsiveness, and apnea. The clinical diagnosis was necrotizing enterocolitis. Abdominal X-ray showed that the abdominal bowel was significantly dilated and inflated. The patient was immediately treated with fasting, gastrointestinal decompression, enema, and anti-infection treatment. After 40 days in hospital, the patient recovered and was discharged.


Asunto(s)
Anemia , Enterocolitis Necrotizante , Nacimiento Prematuro , Transfusión Sanguínea , Enterocolitis Necrotizante/etiología , Edad Gestacional , Humanos , Lactante , Recién Nacido , Masculino
3.
Rev Saude Publica ; 55: 59, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34932705

RESUMEN

OBJECTIVE: To investigated the effect of oropharyngeal colostrum immunotherapy in reducing the time required for very low birth weight preterm newborns (VLBW-PTNB: < 1,500g and < 37 weeks) to achieve full enteral nutrition. METHODS: Literature search was conducted using four databases, including gray literature, with additional manual search of the references of selected articles. Eligibility criteria consisted of randomized clinical trials, without restriction regarding the date or language of the publication. Two independent reviewers performed the article selection and data extraction. The random-effects meta-analysis used a non-standard technique to assess the mean difference in days to achieve full enteral nutrition, carried out by the Stata 15 statistic program. RESULTS: The systematic review comprised 10 studies, and five were selected for meta-analysis, with a population of 764 VLBW-PTNB and gestational age of birth between 25 and 32 weeks. The studies were conducted between 2011 and 2018 in North America, Asia and Africa, with only one conducted in South America. Altogether, they reported the number of days it took 708 VLBW-PTNB to achieve full enteral nutrition, with newborns treated with immunotherapy showing a shorter time in only three studies. Meta-analysis showed a mean difference of -4.26 days, (95% CI -7.44; -1.08d), with high heterogeneity (I2 = 83.1%). CONCLUSION: The use of oropharyngeal colostrum immunotherapy can reduce the time for VLBW-PTNB to achieve full nutrition when compared to those who used a placebo or received routine care.


Asunto(s)
Calostro , Enterocolitis Necrotizante , Brasil , Femenino , Humanos , Inmunoterapia , Lactante , Recién Nacido , Recien Nacido Prematuro , Embarazo
4.
Ulus Travma Acil Cerrahi Derg ; 27(6): 662-667, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34710230

RESUMEN

BACKGROUND: The aim of this study is to evaluate the patients with intestinal perforation secondary to necrotizing enterocolitis (NEC) following cardiac surgery in the terms of risk factors and diagnosis/treatment process. METHODS: A series of cases operated for intestinal perforation secondary to NEC were retrospectively reviewed in two groups. Group I involved patients who had cardiac surgery for congenital heart disease previous to intestinal perforation secondary to NEC. Group II consisted patients who had intestinal perforation secondary to NEC without any previous cardiac surgery. Demographic characteristics, prenatal and postnatal features, and pre- and post-operative course of groups were statistically compared to define differences. RESULTS: Thirty-two patients underwent laparotomy secondary to intestinal perforation in this period. The gestational age and birth weight were smaller in Group II (p=0.001, p=0.001). Intrauterine growth retardation was more frequent in Group II (p=0.05). More Group I patients had hypotensive periods (p=0.018) before the diagnosis of NEC. Prostaglandin treatment and requirement of renal replacement therapy were more frequent in Group I (p=0.022, p=0.03). The mortality rate was higher in Group I (p=0.018). All patients in Group I were late stage NEC at the time of diagnosis. CONCLUSION: NEC developing after cardiac surgery is different from NEC seen in the neonatal period in the terms of etiology, facilitating factors, and clinical course. Mortality rate is higher in NEC after cardiac surgery. The diagnosis of intestinal perforation might be difficult in NEC after cardiac surgery due to insignificant physical examination findings and characteristic radiological signs of NEC. The history of prostaglandin usage and requirement of renal replacement were thought as alarming signs in terms of possible intestinal complications after cardiac surgery.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Enterocolitis Necrotizante , Perforación Intestinal , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Enterocolitis Necrotizante/complicaciones , Enterocolitis Necrotizante/cirugía , Femenino , Humanos , Recién Nacido , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Laparotomía , Embarazo , Estudios Retrospectivos
5.
BMC Pediatr ; 21(1): 454, 2021 10 18.
Artículo en Inglés | MEDLINE | ID: mdl-34657609

RESUMEN

BACKGROUND: Enemas are used in preterm infants to promote meconium evacuation, but frequent high-volume enemas might contribute to focal intestinal perforation (FIP). To replace a regime consisting of frequent enemas of varying volume and composition, we implemented a once-daily, low-volume lipid enema (LE) regimen. We investigated its impact on meconium evacuation, enteral nutrition, and gastrointestinal complications in preterm infants. METHODS: We performed a single-center retrospective study comparing cohorts of preterm infants < 28 weeks gestation or < 32 weeks, but with birth weight < 10th percentile, before and after implementing LE. Outcomes were rates of FIP, necrotizing enterocolitis (NEC), and sepsis. We assessed stooling patterns, early enteral and parenteral nutrition. We used descriptive statistics for group comparisons and logistic regression to identify associations between LE and gastrointestinal complications and to adjust for group imbalances and potential confounders. Exclusion criteria were gastrointestinal malformations or pre-determined palliative care. RESULTS: Data from 399 infants were analyzed, 203 before vs. 190 after implementing LE; in the latter period, 55 protocol deviations occurred where infants received no enema, resulting in 3 groups with either variable enemas, LE or no enema use. Rates of FIP and sepsis were 11.9% vs. 6.4% vs. 0.0% and 18.4% vs. 13.5% vs. 14.0%, respectively. NEC rates were 3.0% vs. 7.8% vs. 3.5%. Adjusted for confounders, LE had no effect on FIP risk (aOR 1.1; 95%CI 0.5-2.8; p = 0.80), but was associated with an increased risk of NEC (aOR 2.9; 95%CI 1.0-8.6; p = 0.048). While fewer enemas were applied in the LE group resulting in a prolonged meconium passage, no changes in early enteral and parenteral nutrition were observed. We identified indomethacin administration and formula feeding as additional risk factors for FIP and NEC, respectively (aOR 3.5; 95%CI 1.5-8.3; p < 0.01 and aOR 3.4; 95%CI 1.2-9.3; p = 0.02). CONCLUSION: Implementing LE had no clinically significant impact on meconium evacuation, early enteral or parenteral nutrition. FIP and sepsis rates remained unaffected. Other changes in clinical practice, like a reduced use of indomethacin, possibly affected FIP rates in our cohorts. The association between LE and NEC found here argues against further adoption of this practice. TRIAL REGISTRATION: Registered at the German Register of Clinical Trials (no. DRKS00024021 ; Feb 022021).


Asunto(s)
Enterocolitis Necrotizante , Meconio , Enema/efectos adversos , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Lípidos , Estudios Retrospectivos
8.
Adv Neonatal Care ; 21(5): 365-370, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34469367

RESUMEN

BACKGROUND: Abdominal x-ray (KUB) routinely aids in detecting necrotizing enterocolitis (NEC), one of the most serious neonatal intestinal diseases. However, a KUB may miss up to 50% of the early signs of NEC. Recent advances in abdominal ultrasound (AUS) can expedite this diagnosis and improve clinical management. PURPOSES: To illustrate AUS findings that suggest NEC through 3 case examples. To review current literature regarding advantages and limitations of AUS compared with KUB. RESULTS: The added visualization of intra-abdominal structures with AUS compared with KUB improves the diagnosis and management of NEC. Some AUS features are highly suggestive of impending bowel perforation, while others can confirm bowel perforation despite a negative radiograph. IMPLICATIONS FOR PRACTICE: AUS expedites time to diagnosis of NEC and helps to stratify patients who may fail medical management and require surgical intervention. IMPLICATIONS FOR RESEARCH: More quality improvement studies are needed to validate an AUS protocol for the management of NEC. Advances in technology, such as contrast-enhanced ultrasound, may improve NEC detection with AUS in the future.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.


Asunto(s)
Enterocolitis Necrotizante , Enfermedades del Recién Nacido , Enterocolitis Necrotizante/diagnóstico por imagen , Enterocolitis Necrotizante/terapia , Humanos , Recién Nacido , Radiografía , Ultrasonografía
10.
Ann Surg ; 274(4): e370-e380, 2021 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-34506326

RESUMEN

OBJECTIVE: The aim of this study was to determine which initial surgical treatment results in the lowest rate of death or neurodevelopmental impairment (NDI) in premature infants with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP). SUMMARY BACKGROUND DATA: The impact of initial laparotomy versus peritoneal drainage for NEC or IP on the rate of death or NDI in extremely low birth weight infants is unknown. METHODS: We conducted the largest feasible randomized trial in 20 US centers, comparing initial laparotomy versus peritoneal drainage. The primary outcome was a composite of death or NDI at 18 to 22 months corrected age, analyzed using prespecified frequentist and Bayesian approaches. RESULTS: Of 992 eligible infants, 310 were randomized and 96% had primary outcome assessed. Death or NDI occurred in 69% of infants in the laparotomy group versus 70% with drainage [adjusted relative risk (aRR) 1.0; 95% confidence interval (CI): 0.87-1.14]. A preplanned analysis identified an interaction between preoperative diagnosis and treatment group (P = 0.03). With a preoperative diagnosis of NEC, death or NDI occurred in 69% after laparotomy versus 85% with drainage (aRR 0.81; 95% CI: 0.64-1.04). The Bayesian posterior probability that laparotomy was beneficial (risk difference <0) for a preoperative diagnosis of NEC was 97%. For preoperative diagnosis of IP, death or NDI occurred in 69% after laparotomy versus 63% with drainage (aRR, 1.11; 95% CI: 0.95-1.31); Bayesian probability of benefit with laparotomy = 18%. CONCLUSIONS: There was no overall difference in death or NDI rates at 18 to 22 months corrected age between initial laparotomy versus drainage. However, the preoperative diagnosis of NEC or IP modified the impact of initial treatment.


Asunto(s)
Drenaje , Enterocolitis Necrotizante/cirugía , Enfermedades del Prematuro/cirugía , Perforación Intestinal/cirugía , Laparotomía , Trastornos del Neurodesarrollo/epidemiología , Enterocolitis Necrotizante/mortalidad , Enterocolitis Necrotizante/psicología , Estudios de Factibilidad , Femenino , Humanos , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/mortalidad , Enfermedades del Prematuro/psicología , Perforación Intestinal/mortalidad , Perforación Intestinal/psicología , Masculino , Trastornos del Neurodesarrollo/diagnóstico , Tasa de Supervivencia , Resultado del Tratamiento
11.
Pediatr Cardiol ; 42(8): 1688-1699, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34510235

RESUMEN

Infants with congenital heart disease (CHD) are at an increased risk of developing necrotising enterocolitis (NEC), a serious inflammatory intestinal condition classically associated with prematurity. CHD not only increases the risk of NEC in preterm infants but is one of the most commonly implicated risk factors in term infants. Existing knowledge on the topic is limited largely to retrospective studies. This review acts to consolidate existing knowledge on the topic in terms of disease incidence, pathophysiology, risk factors, outcomes and the complex relationship between NEC and enteral feeds. Potential preventative strategies, novel biomarkers for NEC in this population, and the role of the intestinal microbiome are all explored. Numerous challenges exist in the study of this complex multifactorial disease which arise from the heterogeneity of the affected population and its relative scarcity. Nevertheless, its high related morbidity and mortality warrant renewed interest in identifying those infants most at risk and implementing strategies to reduce the incidence of NEC in infants with CHD.


Asunto(s)
Enterocolitis Necrotizante , Cardiopatías Congénitas , Niño , Enterocolitis Necrotizante/epidemiología , Enterocolitis Necrotizante/etiología , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/epidemiología , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Estudios Retrospectivos
13.
BMC Pediatr ; 21(1): 420, 2021 09 23.
Artículo en Inglés | MEDLINE | ID: mdl-34556084

RESUMEN

BACKGROUND: In-utero weight gain can be achieved in very preterm infants through rapid advancement of enteral feeds without increasing risk of necrotizing enterocolitis. There are concerns, however, that such rapid weight gain may lead to an increased childhood adiposity risk, although long-term data are sparse. DESIGN: This retrospective observational study included two well-characterized cohorts comprising 145 infants born at < 28 weeks or with < 1000 g birth weight. We investigated associations between advancing enteral feeding volumes in daily increments of 15-20 ml/kg (Cohort 1, n = 84, born in 2006/2007) vs. 25-30 ml/kg (Cohort 2, n = 61, born in 2010) and growth up to 5 years of age. RESULTS: There was no significant difference in anthropometric parameters post discharge to 5 years between both cohorts. Standard deviation score (SDS) weight and SDS BMI at the age of 5 years remained lower than in the reference population. SDS weight decreased from discharge to about 10-12 months postnatal age and returned to birth values by age 5 years. There was a catch-up for SDS length/height from discharge to 5 years; SDS head circumference decreased from birth to 5 years. Multiple regression analyses revealed that for all anthropometric parameters SDS at birth was the most important predictor for SDS at 5 years. Early parenteral protein intake may be another important factor, at least for head growth. CONCLUSIONS: Growth was similar in both cohorts without benefit from more accelerated feeding advancement in cohort 2. In both cohorts, early enteral nutrition was associated with in-hospital weight gain as in utero, a drop in weight SDS post discharge and catch-up to birth SDS until age 5 years, remaining below the reference population. Length showed catch-up form discharge to 5 years, whereas head circumference progressively deviated from the reference population. Increased parenteral protein supplementation may be needed to accompany early enteral feeding advancements.


Asunto(s)
Nutrición Enteral , Enterocolitis Necrotizante , Adolescente , Cuidados Posteriores , Niño , Preescolar , Humanos , Lactante , Recien Nacido Extremadamente Prematuro , Recién Nacido , Recién Nacido de muy Bajo Peso , Alta del Paciente
14.
J Pediatr Gastroenterol Nutr ; 73(5): 654-658, 2021 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-34347677

RESUMEN

OBJECTIVE: Infants requiring intestinal resection because of necrotizing enterocolitis (NEC) or small bowel atresia (SBA) may benefit from mucous fistula refeeding (MFR) of enterostomy output to improve nutrition and bowel adaptation before reanastomosis. Previous series demonstrated improved outcomes with MFR but did not account for varied patient characteristics as potential sources of bias. We performed a cohort analysis using multivariable adjusted models to compare outcomes of patients with and without MFR. METHODS: Retrospective chart review was performed for patients with NEC or SBA and small bowel resection with enterostomy and MF. Demographic and outcome data was compared between MFR and non-MFR groups using adjusted multivariable analysis for potential confounding variables. RESULTS: MFR was performed in 65 of 101 patients (64%), including 45 of 75 patients with NEC and 20 of 26 patients with SBA. Reasons for not receiving MFR included bowel stricture, technical limitation, or not otherwise specified. NEC patients receiving MFR had 14 fewer days to achieve full enteral feeds after intestinal reconnection, 22 fewer days of parenteral nutrition, lower peak direct bilirubin by 2.4 mg/dL, and 77% less odds of ursodiol use (all P < 0.01). SBA patients had similar trends not reaching statistical significance. Growth parameters were improved in MFR groups. There were no complications or increased infections from MFR. CONCLUSIONS: This study suggests that MFR safely improves nutritional outcomes in infants with intestinal resection, related to decreased total parenteral nutrition (TPN) dependence and earlier enteral autonomy.


Asunto(s)
Enterocolitis Necrotizante , Enterostomía , Fístula , Enterocolitis Necrotizante/etiología , Enterocolitis Necrotizante/cirugía , Humanos , Lactante , Recién Nacido , Intestinos , Estudios Retrospectivos
15.
Bol Med Hosp Infant Mex ; 78(4): 331-334, 2021.
Artículo en Español | MEDLINE | ID: mdl-34351891

RESUMEN

El desarrollo de enterocolitis necrosante, con la consecuente perforación intestinal, es frecuente en los recién nacidos pretérmino. El tratamiento estándar de la perforación intestinal es quirúrgico. Sin embargo, se sugiere que la inserción de un drenaje en el abdomen puede ser efectivo para tratar esta afección. Se resumen los resultados de una revisión sistemática Cochrane que compara la efectividad del drenaje peritoneal con la de la laparotomía en neonatos con enterocolitis necrosante perforada.Necrotizing enterocolitis is common in preterm newborns, with consequent intestinal perforation. The standard treatment for intestinal perforation is surgery. However, it is suggested that inserting a drain into the abdomen may be effective in treating this condition. This document summarizes the results of a Cochrane systematic review comparing the effectiveness of peritoneal drainage with laparotomy in neonates with perforated necrotizing enterocolitis.


Asunto(s)
Enterocolitis Necrotizante , Enfermedades del Recién Nacido , Drenaje , Enterocolitis Necrotizante/cirugía , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Laparotomía
16.
PLoS One ; 16(8): e0255783, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34407091

RESUMEN

OBJECTIVE: The present study seeks to assess the impact of gestational hypertensive disorders on premature newborns below 34 weeks and to establish the main morbidities and mortality in the neonatal period and at 18 months. MATERIALS AND METHODS: A retrospective observational study was carried out with 695 premature newborns of gestational age (GA) between 24 and 33 weeks and 6 days, born alive in the Neonatal ICU of Brasília's Mother and Child Hospital (HMIB), in the period from January 1, 2014, to July 31, 2019. In total, 308 infants were born to hypertensive mothers (G1) and 387 to normotensive mothers (G2). Twin pregnancies and diabetic patients with severe malformations were excluded. Outcomes during hospitalization and outcomes of interest were evaluated: respiratory distress syndrome (RDS), brain ultrasonography, diagnosis of bronchopulmonary dysplasia (BPD), diagnosis of necrotizing enterocolitis, retinopathy of prematurity, breastfeeding rate at discharge, survival at discharge and at 18 months of chronological age and relationship between weight and gestational age. RESULTS: Newborns with hypertensive mothers had significantly lower measurements of birth weight and head circumference. The G1 group had a higher risk small for gestational age (OR 2.4; CI 95% 1.6-3.6; p <0.00), as well as a greater risk of being born with a weight less than 850 g (OR 2.4; 95% CI 1.2-3.5; p <0.00). Newborns of mothers with hypertension presented more necrotizing enterocolitis (OR 2.0; CI 95% 1.1-3.7); however, resuscitation in the delivery room and the need to use surfactant did not differ between groups, nor did the length of stay on mechanical ventilation, or dependence on oxygen at 36 weeks of gestational age. Survival was better in newborns of normotensive mothers, and this was a protective factor against death (OR 0.7; 95% CI 0.5-0.9; p <0.01). In the follow-up clinic, survival at 18 months of chronological age was similar between groups, with rates of 95.3% and 92.1% among hypertensive and normotensive mothers, respectively. Exclusive breastfeeding at discharge was 73.4% in the group of hypertensive women and 77.3% in the group of normotensive mothers. There were no significant differences between groups. CONCLUSION: Among the analyzed outcomes, arterial hypertension during pregnancy can increase the risk of low weight, small babies for gestational age (SGA), deaths in the neonatal period and enterocolitis, with no differences in weight and survival at 18 months of chronological age. Arterial hypertension presents a high risk of prematurity in the neonatal period, with no difference at 18 months of age.


Asunto(s)
Hipertensión Inducida en el Embarazo/epidemiología , Enfermedades del Recién Nacido/epidemiología , Complicaciones Cardiovasculares del Embarazo/epidemiología , Displasia Broncopulmonar , Enterocolitis Necrotizante/epidemiología , Enterocolitis Necrotizante/fisiopatología , Femenino , Edad Gestacional , Humanos , Hipertensión Inducida en el Embarazo/fisiopatología , Lactante , Mortalidad Infantil , Recien Nacido Extremadamente Prematuro/fisiología , Recién Nacido , Enfermedades del Recién Nacido/fisiopatología , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/fisiopatología , Recién Nacido Pequeño para la Edad Gestacional/fisiología , Recién Nacido de muy Bajo Peso/fisiología , Unidades de Cuidado Intensivo Neonatal , Embarazo , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Respiración Artificial , Síndrome de Dificultad Respiratoria del Recién Nacido/epidemiología , Síndrome de Dificultad Respiratoria del Recién Nacido/fisiopatología , Estudios Retrospectivos
17.
J Pediatr Surg ; 56(11): 1911-1915, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34392969

RESUMEN

BACKGROUND: Necrotizing enterocolitis (NEC) is a neonatal disease associated with necrosis and perforation of the bowel. We investigated the association between blood group and NEC outcomes and the potential contribution of fetal-maternal blood group incompatibility. METHODS: Retrospective study including all preterm-born infants with NEC (≥ Bell's stage IIa) admitted to our NICU between January 2008 and October 2019. We analyzed the association between infants' blood groups and fetal-maternal blood group incompatibility with Bell stage severity, need for surgery, and mortality due to NEC. RESULTS: We included 237 NEC patients. In univariable analyses both AB blood group and fetal-maternal blood group incompatibility increased infants' risk of severe outcomes, with odds ratios (OR) ranging from 6.57 to 12.06 and 1.97 to 2.38, respectively. When adjusted for gestational age only AB blood group remained significant with OR 7.47 (95% confidence interval, 1.95-28.53, P = 0.003), 12.37 (2.63-58.20, P = 0.001), and 8.16 (2.28-29.14, P = 0.001) for NEC Bell's stage III, need for surgery, and NEC related mortality, respectively. Blood group incompatibility adjusted for gestational age was not related to worse outcomes with OR 1.84 (0.87-3.89, P = 0.11, 2.08 (0.98-4.41, P = 0.06) 1.52 (0.68-3.42, P = 0.31), for NEC Bell's stage III, need for surgery, and NEC related mortality, respectively. CONCLUSION: Our data confirm an association between blood group AB and worse outcomes in NEC infants, but this is not based on fetal-maternal blood group incompatibility.


Asunto(s)
Antígenos de Grupos Sanguíneos , Enterocolitis Necrotizante , Enfermedades del Recién Nacido , Humanos , Lactante , Recién Nacido , Estudios Retrospectivos , Factores de Riesgo
18.
Cochrane Database Syst Rev ; 8: CD012322, 2021 08 19.
Artículo en Inglés | MEDLINE | ID: mdl-34415568

RESUMEN

BACKGROUND: There is presently no certainty about the ideal feeding intervals for preterm infants. Shorter feeding intervals of, for example, two hours, have the theoretical advantage of allowing smaller volumes of milk. This may have the potential to reduce the incidence and severity of gastro-oesophageal reflux. Longer feeding intervals have the theoretical advantage of allowing more gastric emptying between two feeds. This potentially provides periods of rest (and thus less hyperaemia) for an immature digestive tract. OBJECTIVES: To determine the safety of shorter feeding intervals (two hours or shorter) versus longer feeding intervals (three hours or more) and to compare the effects in terms of days taken to regain birth weight and to achieve full feeding. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to run comprehensive searches in CENTRAL (2020, Issue 6) and Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions, and CINAHL on 25 June 2020. We searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-RCTs. SELECTION CRITERIA: We included RCTs and quasi-RCTs comparing short (e.g. one or two hours) versus long (e.g. three or four hours) feeding intervals in preterm infants of any birth weight, all or most of whom were less than 32 weeks' gestation. Infants could be of any postnatal age at trial entry, but eligible infants should not have received feeds before study entry, with the exception of minimal enteral feeding. We included studies of nasogastric or orogastric bolus feeding, breast milk or formula, in which the feeding interval is the intervention. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Our primary outcomes were days taken to achieve full enteral feeding and days to regain birth weight. Our other outcomes were duration of hospital stay, episodes of necrotising enterocolitis (NEC) and growth during hospital stay (weight, length and head circumference). MAIN RESULTS: We included four RCTs, involving 417 infants in the review. One study involving 350 infants is awaiting classification. All studies compared two-hourly versus three-hourly feeding interval. The risk of bias of the included studies was generally low, but all studies had high risk of performance bias due to lack of blinding of the intervention. Three studies were included in meta-analysis for the number of days taken to achieve full enteral feeding (351 participants). The mean days to achieve full feeds was between eight and 11 days. There was little or no difference in days taken to achieve full enteral feeding between two-hourly and three-hourly feeding, but this finding was of low certainty (mean difference (MD) ‒0.62, 95% confidence interval (CI) ‒1.60 to 0.36). There was low-certainty evidence that the days taken to regain birth weight may be slightly longer in infants receiving two-hourly feeding than in those receiving three-hourly feeding (MD 1.15, 95% CI 0.11 to 2.20; 3 studies, 350 participants). We are uncertain whether shorter feeding intervals have any effect on any of our secondary outcomes including the duration of hospital stay (MD ‒3.36, 95% CI ‒9.18 to 2.46; 2 studies, 207 participants; very low-certainty evidence) and the risk of NEC (typical risk ratio 1.07, 95% CI 0.54 to 2.11; 4 studies, 417 participants; low-certainty evidence). No study reported growth during hospital stay. AUTHORS' CONCLUSIONS: The low-certainty evidence we found in this review suggests that there may be no clinically important differences between two- and three-hourly feeding intervals. There is insufficient information about potential feeding complications and in particular NEC. No studies have looked at the effect of other feeding intervals and there is no long-term data on neurodevelopment or growth.


Asunto(s)
Nutrición Enteral/métodos , Recien Nacido Prematuro/crecimiento & desarrollo , Recién Nacido de muy Bajo Peso/crecimiento & desarrollo , Leche Humana , Aumento de Peso , Peso al Nacer , Nutrición Enteral/efectos adversos , Enterocolitis Necrotizante/epidemiología , Enterocolitis Necrotizante/prevención & control , Humanos , Lactante , Fórmulas Infantiles , Recién Nacido , Factores de Tiempo , Resultado del Tratamiento
19.
BMC Pediatr ; 21(1): 355, 2021 08 21.
Artículo en Inglés | MEDLINE | ID: mdl-34418984

RESUMEN

BACKGROUND: This study aims to investigate clinical significance of HMGB1 in neonatal patients with necrotizing enterocolitis (NEC). METHODS: This observational study enrolled a total of 106 stage II-III NEC neonatal patients, who were admitted in our hospital from March 2014 to March 2019. In addition, 99 suspected NEC patients and 200 healthy controls were included. The serum levels of HMGB1, I-FABP, and inflammatory factors CRP, IL-1ß, IL-6 and TNF-α were determined by enzyme-linked immunosorbent assay (ELISA). Then, the demographic data and clinical characteristics of all patients were collected. Statistical analysis was conducted to determine the correlation between HMGB1 and the clinical characteristics. RESULTS: No significant difference was found in the basic characteristics of NEC patients and healthy controls, except for birth weight and gestational age. The expression levels of HMGB1, I-FABP, and inflammatory factors IL-1ß, IL-6 and TNF-α were significantly higher in NEC patients, when compared to healthy controls. The serum levels of HMGB1, I-FABP, IL-1ß and IL-6 markedly increased in stage II-III NEC patients, when compared to stage I NEC patients. The Pearson's analysis revealed a positive correlation between HMGB1 and I-FABP, HMGB1 and IL-1ß, and HMGB1 and IL-6. The ROC curve revealed that both HMGB1 and I-FABP can potentially be used as diagnostic factors for NEC. The logistic multivariate regression revealed that I-FABP, IL-1ß and IL-6 are independent risk factors for mortality in neonatal NEC patients. CONCLUSIONS: Serum HMGB1 levels are upregulated in neonatal NEC patients, and these are correlated with the patient's prognosis.


Asunto(s)
Enterocolitis Necrotizante , Proteína HMGB1/metabolismo , Enterocolitis Necrotizante/diagnóstico , Edad Gestacional , Proteína HMGB1/sangre , Humanos , Recién Nacido , Pronóstico , Curva ROC
20.
Front Cell Infect Microbiol ; 11: 694395, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34422680

RESUMEN

Autoinducer-2 (AI-2) is believed to be a bacterial interspecies signaling molecule that plays an important role in the regulation of the physiological behaviors of bacteria. The effect of AI-2 on the process of necrotizing enterocolitis (NEC) is unknown, and the aim of this study was to study the effect of AI-2 in a mouse NEC model. C57BL/6 mouse pups were randomly divided into three groups: the control group, the NEC group, and the NEC+AI-2 (NA) group. Exogenous AI-2 (500 nM) was added to the formula milk of the NA group. The concentrations of fecal AI-2 and flora were tested. The expression of cytokines, TLR4 and NF-κB in intestinal tissue was detected. The AI-2 level was significantly decreased in the NEC group (P<0.05). Compared with the NEC group, the intestinal injury scores, expression of TLR4, NF-kB, and proinflammatory factors (IL-1ß, IL-6, IL-8 and TNF-α) were reduced, and expression of anti-inflammatory factor (IL-10) was increased in the NA group mice (P<0.05). At the phylum level, the Proteobacteria abundance in the NA group was significantly increased, while the Bacteroidota abundance in the control group was significantly increased (P<0.05). At the genus level, Helicobacter and Clostridium_sensu_stricto_1 exhibited significantly greater abundance in the NEC group than in the other two groups, while Lactobacillus had the opposite trend (P<0.05). In addition, the abundances of Klebsiella, Rodentibacter and Enterococcus were significantly higher in the NA group than in the NEC and control groups (P < 0.05). Exogenous AI-2 partially reverses flora disorder and decreases inflammation in an NEC mouse model.


Asunto(s)
Enterocolitis Necrotizante , Animales , Animales Recién Nacidos , Disbiosis , Enterocolitis Necrotizante/tratamiento farmacológico , Inflamación/tratamiento farmacológico , Ratones , Ratones Endogámicos C57BL
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...