Low technology, mild controlled hypothermia for necrotizing enterocolitis treatment: an initiative to improve healthcare to preterm neonates.

Necrotizing enterocolitis (NEC) treatment remains unchanged for years. Data suggest that mild controlled hypothermia could potentially improve NEC outcomes. Our units presented unfavourable outcomes on NEC. The aim was to assess our experience with low technology, mild controlled hypothermia on NEC outcomes, and improve preterm infants' healthcare. This was a single-center quality improvement study with retrospective cohort design at the neonatal intensive care unit in the university hospital. Forty-three preterm infants with NEC (Modified Bell's Stage II/III) were included: 19 in the control group (2015-2018) and 24 in the hypothermia group (2018-2020). The control group received standard treatment (fasting, abdominal decompression, and broad-spectrum antibiotics). The hypothermia group underwent cooling to 35.5 °C for 48 h after NEC diagnosis, along with conventional treatment. The primary outcomes are intestinal perforation, need for surgery, duration of parenteral nutrition, death, and extensive resection of the small intestine. There was no statistical difference in the NEC score. The hypothermia group required less surgery (aRR 0.40; 95% CI 0.19-0.85), presented less bowel perforation (aRR 0.39; 95% CI 0.18; 0.83), had a shorter duration of parenteral nutrition (aHR 5.28; 95% CI 1.88-14.89), did not need extensive intestinal resection, (0 vs 15.7%), and did not experience any deaths (0 vs 31.6%).Conclusions: In our experience, low technology, mild controlled hypothermia was feasible, not related to adverse effects, and effective treatment for NEC Modified Bell's Stage II/III. It avoided surgery, bowel perforation, and extensive intestinal resection; reduced mortality; and shortened parenteral nutrition duration. What is Known: • New approaches have been proposed to avoid enterocolitis incidence; however, the treatment of enterocolitis stage 2 has been the same for decades, and unfavourable outcomes remain despite conventional management. • Studies suggest that hypothermia can be an alternative to enterocolitis treatment. What is New: • Mild controlled hypothermia can be an additional practice to treat enterocolitis stage 2, is feasible, and is not related to adverse effects to preterm infants. • It can decrease surgery needs, duration of parenteral nutrition, and death and avoids extensive intestinal resection in preterm infants.

Intervenção nutricional pré-operatória e a evolução de crianças submetidas à cirurgia cardíaca para correção de cardiopatias congênitas: estudo piloto / Preoperative nutritional intervention and the evolution of children submitted to cardiac surgery for the correction of congenital heart diseases: a pilot study

Introdução: O objetivo desta pesquisa foi investigar se lactentes e crianças submetidas à correção cirúrgica de cardiopatias congênitas com circulação extracorpórea com melhor evolução pósoperatória tiveram melhores parâmetros nutricionais antes da cirurgia. Método: Trata-se de um estudo piloto, clínico prospectivo, intervencionista, não-controlado, que incluiu 11 crianças com idade > 30 dias e ≤ 5 anos, com cardiopatia congênita, divididas em dois grupos, de acordo com a duração da internação e o índice de massa corporal (IMC) no dia da alta hospitalar. Os pacientes receberam orientação nutricional para atingir o aporte energético e, quando necessário, foi utilizada suplementação com fórmula láctea. Dados gerais, antropométricos, ingestão calórica e proteica, exames laboratoriais, avaliação da composição corporal (por meio do ângulo de fase) foram obtidos. Resultados: A intervenção nutricional levou à melhora dos parâmetros nutricionais no período pré-operatório dos pacientes, porém não foi possível demonstrar efeitos sobre os principais desfechos pós-operatórios, pois não encontramos diferença significativa quanto ao peso e valor de ângulo de fase após a intervenção nutricional. Contudo, encontramos aumento significativo do IMC no período pré-operatório no grupo em que houve menor tempo de internação na UTI pediátrica. Conclusão: Podemos concluir que o adequado estado nutricional de crianças cardiopatas prévio à correção cirúrgica é fundamental para a boa evolução pós-operatória. A avaliação e intervenção nutricional prévias à cirurgia são de extrema importância, pois têm como objetivo otimizar a recuperação e minimizar o tempo de estadia hospitalar.(AU)

Introduction: The objective of this research was to investigate whether infants and children undergoing surgical correction of congenital heart disease with cardiopulmonary bypass with better postoperative outcomes have had better nutritional conditions before surgery. Methods: It is a study prospective pilot clinical, interventional, uncontrolled study, which included 11 children aged > 30 days and ≤ 5 years, with congenital heart disease, divided into two groups according to hospital length-of-stay and the body mass index (BMI) at hospital discharge. The patients received dietary guidance to reach the energy requirements and, when necessary, supplementary milk formula was used. Demographic, anthropometric, and caloric date, and protein intake, lab tests, and assessment of body composition (through the phase angle), were obtained. Results: Nutritional intervention led to improvements in nutritional parameters before surgery, but effects on major postoperative outcomes could not be demonstrated; therefore, no significant differences were found in weight and phase angle values after nutritional intervention. Nevertheless, we found a significant increase in BMI in the preoperative period in the group that had shorter Intensive Care Unit length-of-stay. Conclusion: We can conclude that an adequate nutritional status in children with heart disease, prior to surgical correction, is desirable to achieve good postoperative outcomes. Nutritional assessment and intervention prior to surgery are extremely important, aiming at minimizing hospital length-of-stay.(AU)