Antibiotic exposure and development of necrotizing enterocolitis in very preterm neonates

Esmaeilizand, Rana; Yoon, Eugene W.; Shah, Prakesh S.; Harrison, Adele; Synnes, Anne; Sokoran, Todd; Yee, Wendy; Aziz, Khalid; Kalapesi, Zarin; Sankaran, Koravangattu; Seshia, Mary; Alvaro, Ruben; Shivananda, Sandesh; Silva, Orlando da; Nwaesei, Chuks; Lee, Kyong-Soon; Dunn, Michael; Rouvinez-Bouali, Nicole; Dow, Kimberly; Pelausa, Ermelinda; Barrington, Keith J.; Drolet, Christine; Riley, Patricia; Bertelle, Valérie; Canning, Rody; Bulleid, Barbara; Ojah, Cecil; Monterrosa, Luis; Deshpandey, Akhil; Afifi, Jehier; Kajetanowicz, Andrzej; Lee, Shoo K.

doi:10.1093/pch/pxx169

Cited by 37 publications

(22 citation statements)

References 33 publications

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“…Several studies have also identified inequality in the care of very low birth weight infants by race, with non-Hispanic Black and Hispanic infants receiving care at lower-quality hospitals compared to non-Hispanic White infants ( 38 – 41 ). While the exact reasons for variation in NEC incidence and outcomes across hospitals are unclear, clinical practice variables identified in the literature as potential protective mediators of NEC risk include use of standardized feeding protocols ( 42 ), donor breast milk ( 43 ), antibiotic stewardship ( 44 ), and probiotics ( 45 ). Other related variables that can contribute to higher NEC rates include the over-representation of adverse experiences among non-Hispanic Black infants such as poverty, malnutrition, stress, pollutants, and poor education.…”

Section: Possible Explanations For Racial Disparities In Necmentioning

confidence: 99%

Racial Disparities in Necrotizing Enterocolitis

2021

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Necrotizing enterocolitis (NEC) is a serious disease of the intestinal tract affecting 5–10% of pre-term infants with up to 50% mortality in those that require surgery. There is wide variation in the rates and outcomes of NEC by race and ethnicity, and the reasons for this disparity are poorly understood. In this article, we review the epidemiology and discuss possible explanations for racial and ethnic differences in NEC. Most of the current evidence investigating the role of race in NEC comes from North America and suggests that Hispanic ethnicity and non-Hispanic Black race are associated with higher risk of NEC compared to non-Hispanic White populations. Differences in pre-term births, breastfeeding rates, and various sociodemographic factors does not fully account for the observed disparities in NEC incidence and outcomes. While genetic studies are beginning to identify candidate genes that may increase or decrease risk for NEC among racial populations, current data remain limited by small sample sizes and lack of validation. Complex interactions between social and biological determinants likely underly the differences in NEC outcomes among racial groups. Larger datasets with detailed social, phenotypic, and genotypic information, coupled with advanced bioinformatics techniques are needed to comprehensively understand racial disparities in NEC.

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Section: Possible Explanations For Racial Disparities In Necmentioning

confidence: 99%

Racial Disparities in Necrotizing Enterocolitis

2021

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“…The effects of antibiotic exposure are not consistent across studies, and a clear effect was not detected in the studies by La Rosa et al (2014) who showed that antibiotics merely influenced the pace, but not the sequence of the patterned colonization in the preterm gut microbiome (35). Torrazza some of these studies have used a composite outcome of NEC or late-onset sepsis (90)(91)(92)(93)(94). Consistent with these observations, Weintraub et al (2012) noted an association between perinatal exposure to ampicillin and NEC (95).…”

Section: Experimentmentioning

confidence: 99%

Intestinal dysbiosis and necrotizing enterocolitis: assessment for causality using Bradford Hill criteria

et al. 2019

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In recent years, several studies have shown that premature infants who develop NEC frequently display enteric dysbiosis with increased Gram-negative bacteria for several days to weeks prior to NEC onset. The importance of these findings, for the possibility of a causal role of these bacteria in NEC pathogenesis, and for potential value of gut dysbiosis as a biomarker of NEC, is wellrecognized. In this review, we present current evidence supporting the association between NEC in premature infants and enteric dysbiosis, and its evaluation using the Bradford Hill criteria for causality. To provide an objective appraisal, we developed a novel scoring system for causal inference. Despite important methodological and statistical limitations, there is support for the association from several large studies and a meta-analysis. The association draws strength from strong biological plausibility of a role of Gram-negative bacteria in NEC and from evidence for temporality, that dysbiosis may antedate NEC onset. The weakness of the association is in the low level of consistency across studies, and the lack of specificity of effect. There is a need for an improved definition of dysbiosis, either based on a critical threshold of relative abundances or at higher levels of taxonomic resolution.

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“…It develops as a result of altered gut microbiota following empiric initial antibiotic administration for preterm infants leading to overgrowth of pathologic virulent organisms over the commensals. [2][3][4][5] Other causes of gastric pneumatosis include isolated gastric pneumatosis, sepsis, gastritis, congenital hypertrophic pyloric stenosis, displaced gastric tubes, following steroid and cyclooxygenase inhibitor (COX-inhibitor), for example, Ibuprofen exposure, jejunal atresia and non-invasive positive pressure ventilation, especially in babies with cyanotic congenital heart disease and large patent ductus arteriosus. [6][7][8][9] Learning points ► Initial empiric use of antibiotics should not be routinely administered for preterm infants on delivery as it is strongly associated with intestinal dysbiosis and increased incidence of NEC.…”

Section: Images In…mentioning

confidence: 99%

Gastric pneumatosis in a preterm infant following initial empiric antibiotic therapy

Bayoumi

Elmalik

2021

BMJ Case Rep

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Antibiotic exposure and development of necrotizing enterocolitis in very preterm neonates

Abstract: Empiric antibiotic exposure for 5 or more days in preterm neonates born before 29 weeks' gestation was associated with an increased risk of NEC.

Cited by 37 publications

References 33 publications

Racial Disparities in Necrotizing Enterocolitis

Racial Disparities in Necrotizing Enterocolitis

Intestinal dysbiosis and necrotizing enterocolitis: assessment for causality using Bradford Hill criteria

Gastric pneumatosis in a preterm infant following initial empiric antibiotic therapy

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