Antenatal antibiotic exposure in preterm infants with necrotizing enterocolitis

As, Weintraub; Ferrara, Lauren; DeLuca, L; Moshier, Erin; Rs, Green; Oakman, E; Lee, MJ; Rand, Larry

doi:10.1038/jp.2011.180

Cited by 55 publications

(36 citation statements)

References 36 publications

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“…Premature neonates almost universally receive broad-spectrum antibiotics during their first two days of life and many receive more prolonged antibiotic courses for treatment of culture proven or “culture-negative sepsis”. Various retrospective studies have shown that prolonged antenatal 61 and post-natal antibiotic exposure is associated with an increased risk of developing NEC 62–65 . Specifically, a retrospective analysis of 97 matched pairs showed that prenatal exposure to ampicillin was significantly greater in infants with NEC 61 .…”

Section: Necrotizing Enterocolitismentioning

confidence: 99%

“…Various retrospective studies have shown that prolonged antenatal 61 and post-natal antibiotic exposure is associated with an increased risk of developing NEC 62–65 . Specifically, a retrospective analysis of 97 matched pairs showed that prenatal exposure to ampicillin was significantly greater in infants with NEC 61 . Similarly, empirical (culture negative) antibiotics exposure for greater than 5 days has been associated with the development of NEC in numerous studies 62–65 .…”

Section: Necrotizing Enterocolitismentioning

confidence: 99%

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Impact of Antibiotics on Necrotizing Enterocolitis and Antibiotic-Associated Diarrhea

Silverman

Konnikova

Gerber

2017

Gastroenterology Clinics of North America

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Summary Antibiotics induce changes or dysbiosis of the intestinal microbiome. These antibiotic-induce changes may contribute to the pathogenesis of necrotizing enterocolitis (NEC) and antibiotic-associated diarrhea (AAD). Studies are beginning to unravel the contribution of specific groups of microbes to these diseases—most notably Gammaproteobacteria for NEC and bile acid- and carbohydrate-metabolizing microbes for AAD. Antibiotic-associated diarrhea occurs when antibiotic treatment induces diarrhea by altering the metabolic function of the patient’s intestinal microbiota leading to either an osmotic or infectious diarrhea, most notably Clostridium difficile infection (CDI). Antibiotic therapy impairs the host microbiota’s ability to resist colonization or expansion of pathogenic bacteria. In the case of CDI, there is growing evidence that microbiota-mediated bile acid metabolism is critical in the pathogenesis of this infection. Probiotics or other microbiota-targeted therapies may provide effective strategies to prevent and treat NEC and AAD.

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Section: Necrotizing Enterocolitismentioning

confidence: 99%

Section: Necrotizing Enterocolitismentioning

confidence: 99%

Impact of Antibiotics on Necrotizing Enterocolitis and Antibiotic-Associated Diarrhea

Silverman

Konnikova

Gerber

2017

Gastroenterology Clinics of North America

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“…Evidence included in the eNEC™ and nursing intervention practice guide spanned evidence about NEC risk, 59–68 importance of feeding an exclusive human milk diet, 35 beginning trophic feeding early to avoid a prolonged NPO course, 69 careful but consistent advance of feeding, 70 a shared understanding about managing feeding intolerance, 13,71,72 and a consistent nursing response to communicate symptoms and initiate actions when NEC was developing. 43 …”

Section: Two Contemporary Nec Risk Toolsmentioning

confidence: 99%

Prevention and Early Recognition of Necrotizing Enterocolitis

Gephart

Wetzel

Krisman

2014

Advances in Neonatal Care

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Risk for neonatal necrotizing enterocolitis (NEC) is complex, reflecting its multi-factorial pathogenesis. To improve risk awareness and facilitate communication among neonatal caregivers especially nurses, two tools were developed. GutCheckNEC was derived and validated as part of a formal research study over three phases including evidence synthesis, expert consensus building and statistical modeling. The Wetzel/Krisman tool, eNEC™ was developed and tested as part of a quality improvement (QI) initiative in a single clinical setting using evidence synthesis, review by internal expert clinicians and implementation and evaluation of its use by direct line neonatal staff. Refinement of both tools is underway to evaluate their effect on clinical decision making, early identification of NEC and surgical NEC. Clinicians can take an active role to reduce NEC in their units by focusing on modifiable risk factors such as adoption of standardized feeding protocols, preferential feeding of human milk, antibiotic and histamine blocker stewardship. Feeding during transfusion remains controversial but judicious use of transfusions, adoption of transfusion guidelines and withholding feeding during transfusion are feasible measures with potential benefit to prevent NEC and little risk.

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“…Taken antenatally, these antibiotics may affect the neonatal gastrointestinal microbial flora. (6) Several studies also have shown that indomethacin, a nonselective cyclooxygenase inhibitor, given as a tocolytic agent to women in preterm labor, has been associated with neonatal NEC, perhaps by reducing mesenteric blood flow. (7, 8) In addition, there is a clear connection between fetal growth restriction and neonatal NEC, perhaps associated with chronic intrauterine hypoxia.…”

Section: Introductionmentioning

confidence: 99%

Maternal risk factors for neonatal necrotizing enterocolitis

March

Gupta

Modest³

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective This study aimed to investigate the relationship between maternal hypertensive disease and other risk factors and the neonatal development of necrotizing enterocolitis (NEC). Methods This was a retrospective case control study of infants with NEC from 2008 to 2012. The primary exposure of interest was maternal hypertensive disease, which has been hypothesized to put infants at risk for NEC. Other variables collected included demographics, pregnancy complications, medications, and neonatal hospital course. Data was abstracted from medical records. Results 28 cases of singleton neonates with NEC and 81 matched controls were identified and analyzed. There was no significant difference in the primary outcome. Fetuses with an antenatal diagnosis of growth restriction were more likely to develop NEC (p=0.008). Infants with NEC had lower median birth weight than infants without NEC (p=0.009). Infants with NEC had more late-onset sepsis (p=0.01) and mortality before discharge (p=0.001). Conclusions The factors identified by this case-control study that increased the risk of neonatal NEC included intrauterine growth restriction and lower neonatal birth weight. The primary exposure, hypertensive disease, did not show a significantly increased risk of neonatal NEC, however there was a nearly two-fold difference observed. Our study was underpowered to detect the observed difference.

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Antenatal antibiotic exposure in preterm infants with necrotizing enterocolitis

Cited by 55 publications

References 36 publications

Impact of Antibiotics on Necrotizing Enterocolitis and Antibiotic-Associated Diarrhea

Impact of Antibiotics on Necrotizing Enterocolitis and Antibiotic-Associated Diarrhea

Prevention and Early Recognition of Necrotizing Enterocolitis

Maternal risk factors for neonatal necrotizing enterocolitis

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