Necrotizing Enterocolitis Risk State of the Science

College of Nursing, University of Arizona, Tucson, 85721, USA.
Advances in Neonatal Care 04/2012; 12(2):77-87; quiz 88-9. DOI: 10.1097/ANC.0b013e31824cee94
Source: PubMed

ABSTRACT Necrotizing enterocolitis (NEC) is the most common cause of gastrointestinal-related morbidity and mortality in the neonatal intensive care unit (NICU). Its onset is sudden and the smallest, most premature infants are the most vulnerable. Necrotizing enterocolitis is a costly disease, accounting for nearly 20% of NICU costs annually. Necrotizing enterocolitis survivors requiring surgery often stay in the NICU more than 90 days and are among those most likely to stay more than 6 months. Significant variations exist in the incidence across regions and units. Although the only consistent independent predictors for NEC remain prematurity and formula feeding, others exist that could increase risk when combined. Awareness of NEC risk factors and adopting practices to reduce NEC risk, including human milk feeding, the use of feeding guidelines, and probiotics, have been shown to reduce the incidence of NEC. The purpose of this review is to examine the state of the science on NEC risk factors and make recommendations for practice and research.

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    ABSTRACT: AimFetoplacental Doppler abnormalities have been associated with increased neonatal mortality and morbidity. This study evaluated the associations between prenatal Doppler assessments and neonatal mortality and morbidity in premature infants born small for gestational age or after pre-eclampsia.Methods This was a population-based study of infants born alive at 220 - 336 weeks of gestation, a birth weight <10th percentile for gestational age and, or maternal pre-eclampsia. Doppler assessments of the umbilical artery, middle cerebral artery and ductus venosus were evaluated in 127, 125 and 95 cases respectively. Circulatory compromise was defined as absent or reversed end-diastolic velocity in the umbilical artery (AREDF), middle cerebral artery pulsatility index <2.5 percentile for gestational age and ductus venosus pulsatility index for veins >97.5 percentile.ResultsAREDF was present in 28% of the infants. This was associated with increased frequencies of neonatal sepsis and necrotising enterocolitis after adjusting for gestational age. Abnormal ductus venosus pulsatility index for veins was associated with increased risk of neonatal sepsis, but only in combination with AREDF. These associations were only present when gestational age was <28 weeks.ConclusionAREDF was associated with increased neonatal morbidity in premature infants born small for gestational age or after pre-eclampsia.This article is protected by copyright. All rights reserved.
    Acta Paediatrica 12/2014; 104(4). DOI:10.1111/apa.12893 · 1.84 Impact Factor
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    ABSTRACT: Purposes/Aims: To describe a method using Electronic Health Record (EHR) data to derive, validate and test prediction of GutCheckNEC, a composite risk index for Necrotizing Enterocolitis (NEC) and describe opportunities to build the science and practice of risk identification by applying this method in other practice-based evidence contexts. Rationale/ Conceptual Basis/ Background: NEC leads to death in 30-50% of cases, accounts for nearly 20% of US neonatal intensive care (NICU) costs, and is a leading cause of neonatal death. Early identification of NEC is a formidable challenge. Infants who die from NEC are diagnosed, on average, 3 days later than survivors. Composite risk for NEC has not been rigorously tested, although several risk factors have been described. Standardizing communication of NEC risk across multiple handoffs using a risk score could improve treatment for the most vulnerable, improving nurse’s ability to rescue infants with NEC. Methods: Design: A 2-step process of empiric derivation and validation following Pollack’s technique used to derive and test the PRISM III pediatric severity of illness measure was used. Sample: De-identified infant data contained in the Pediatrix BabySteps Clinical Data Warehouse, representing 20% of US NICU admissions from 284 NICUs with discharge dates from 2007-2011 was analyzed including all infants was born before 36 weeks and weighing < 1500 grams (N=58,818). Analysis: The dataset was randomly split into 2/3 for derivation (n=35,005) and 1/3 for validation (n=23,813). Derivation: Risk items were entered into a logistic model according to a theoretical model determined by E-Delphi of experts in Phase I. Risk items significant in univariate analysis (p< .10) were then entered into a multivariate model and then retained or deleted (p< .05). Validation: Beta weights for independent predictors were multiplied by 10, rounded up to the nearest integer value, then a summed risk score was computed. Prediction was tested using Receiver Operator Characteristic (ROC) Curve analysis. Results: Broad variations in NEC rates were identified across the 284 units. Retained items included 9 risk factors (gestational age, transfusion, Unit NEC risk, late onset sepsis, multiple infections, hypotension treated with Inotropic medications, Black or Hispanic race, birth in a different NICU, metabolic acidosis) and 2 risk reducers (human milk feeding on both day 7 and day 14 of life, probiotics). Prediction was good in the validation set for all NEC (AUC=.76, 95% CI .75-.78) and very good for surgical NEC (AUC=.84, 95% CI .82-.84) and NEC leading to death (AUC=.83, 95% CI .81-.85). At a cut-point of 33 (range 0-58), GutCheckNEC was sensitive (.78) and specific (.74). Unit NEC risk carried the most weight in the summed score. Implications: Future research is needed to explore institutional variation in NEC incidence, to inform a NEC-prevention bundle, complete psychometric testing of GutCheckNEC, and automate it for clinical use. Using Electronic Health Record (EHR) data holds promise across settings to build and test clinically usable risk assessments to support just-in-time clinical rescue.
    2014 Western Institute of Nursing Annual Communicating Nursing Research Conference; 04/2013
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    ABSTRACT: Neonatal sepsis and necrotizing enterocolitis (NEC) are two most important neonatal problem in nursery which constitute the bulk of neonatal mortality and morbidity. Inflammatory mediators secondary to sepsis and NEC increases morbidity, by effecting various system of body like lung, brain and eye, thus causing long term implications. Lactoferrin (LF) is a component of breast milk and multiple actions that includes antimicrobial, antiviral, anti-fungal, and anti-cancer and various other actions. Few studies has been completed and number of them are in progress for evaluation of efficacy and safety of LF in the prevention of neonatal sepsis and NEC in field of neonatology. In the coming future LF prophylaxis and therapy may have a significant impact in improving clinical outcomes of vulnerable preterm neonates. This review analyse the role of lactoferrin in prevention of neonatal sepsis and NEC, with emphasis on mechanism of action, recent studies and current studies going on around the globe.
    Journal of Maternal-Fetal and Neonatal Medicine 03/2015; DOI:10.3109/14767058.2015.1017463 · 1.21 Impact Factor


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May 21, 2014