Effect of Feeding Strategies on the Development of Fulminant Necrotizing Enterocolitis

Hartman, Heather A.; Pennell, Christopher; Aronoff, Stephen C.; Arthur, L. Grier

doi:10.1055/s-0040-1715613

Cited by 4 publications

(9 citation statements)

References 12 publications

(13 reference statements)

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“…In this cohort, the age at NEC onset seemed to be higher in the RP-NEC group than in the nRP-NEC group, but this did not reach statistical significance (10 [6, 20] vs. 8 [4,16], p = 0.053). In agreement with our study, Yu et al presented a study showing that a severe condition had a tendency for a later age of onset (10 [7.5, 22.25] vs. 7 [2,14], p = 0.4) (10). However, an earlier age of disease onset for severe NEC has been widely illustrated.…”

Section: Discussionsupporting

confidence: 93%

“…Of the non-surviving NEC patients, some died from a rapid course, called fulminant NEC, which was considered a sub-category condition. Fulminant NEC accounts for 6.7%-28% of the entire NEC population and is associated with a high mortality rate of 95.7%-100% (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

“…The definition of fulminant NEC has been found to be inconsistent in previous studies. Fulminant NEC is defined as death due to NEC within 48 h following diagnosis ( 4 ), as NEC-totalis or death within 72 h of diagnosis ( 2 ), or as pan-intestinal necrosis or death within 48 h of onset ( 5 ). A rapid increase in feeding volume, increased concentration of milk fortifiers, lower birth weight, and earlier gestational age seem to be the risk factors for fulminant NEC.…”

Section: Introductionmentioning

confidence: 99%

“…A rapid increase in feeding volume, increased concentration of milk fortifiers, lower birth weight, and earlier gestational age seem to be the risk factors for fulminant NEC. In addition, fulminant NEC is likely to lead to hematological abnormalities before disease onset or during disease episodes, such as a higher ratio of immature neutrophils, lower lymphocyte counts, and rapid development of thrombocytopenia and neutropenia ( 2 , 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

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Predictive factors for rapid progression in preterm neonates with necrotizing enterocolitis

Chen

Zhong²,

Hou³

et al. 2023

Front. Pediatr.

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BackgroundNecrotizing enterocolitis (NEC) is a devastating gastrointestinal emergency with significant mortality and morbidity rates. A subset of patients progressed rapidly and underwent surgical intervention within a short period. This study aimed to establish a model to predict the rapid progression of NEC in preterm neonates.MethodsA retrospective study was conducted to review neonates with NEC between December 2015 and April 2019 at the Guangzhou Women and Children's Medical Center. Rapidly progressive NEC was defined as the need for surgical intervention or death within 48 h of NEC onset. Patients were divided into two groups: rapidly progressive NEC (RP-NEC) and non-rapidly progressive NEC (nRP-NEC). Data on demographics, perinatal characteristics, examination variables, and radiographic findings at onset were collected.ResultsA total of 216 preterm neonates with NEC were included in the study, of which 64 had RP-NEC and 152 had nRP-NEC. The mortality rates of patients with RP-NEC and nRP-NEC were 32.8% and 3.28%, respectively. Male sex (p-value, adjusted odds ratio [95% confidence interval]: 0.002, 3.43 [1.57, 7.53]), portal venous gas (0.000, 8.82 [3.73, 20.89]), neutrophils <2.0 × 109/L (0.005, 4.44 [1.59, 12.43]), pH <7.3 (7.2 ≤ pH < 7.3) (0.041, 2.95 [1.05, 8.31]), and pH <7.2 (0.000, 11.95 [2.97, 48.12]) at NEC onset were identified as independent risk factors for RP-NEC. An established model that included the four risk factors presented an area under the curve of 0.801 with 83% specificity and 66% sensitivity.ConclusionAmong preterm neonates with NEC, a significantly higher mortality rate was observed in those with rapid progression. It is recommended that close surveillance be performed in these patients, and we are confident that our established model can efficiently predict this rapid progression course.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predictive factors for rapid progression in preterm neonates with necrotizing enterocolitis

Chen

Zhong²,

Hou³

et al. 2023

Front. Pediatr.

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“…A recent study of 80 infants with medical or surgical NEC reported an overall mortality of 36%; however, the mortality in 23 infants with pan-intestinal necrosis was 96%. 19 This extremely high mortality rate confirms the severity of the disease and underscores the need for more research into primary prevention and early recognition of NEC to reduce the risk of fulminant disease.…”

Section: Discussionmentioning

confidence: 70%

Necrotizing Enterocolitis in a Dutch Cohort of Very Preterm Infants: Prevalence, Mortality, and Long-Term Outcomes

et al. 2022

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Introduction To improve counseling of parents and to guide care strategies, we studied the disease course and outcomes of necrotizing enterocolitis (NEC) up to 2 years of corrected age (CA) from a multidisciplinary perspective. Materials and Methods This was a retrospective cohort study in preterm infants (birth weight < 1,500 g, gestational age < 32 weeks), diagnosed with NEC (Bell's stage ≥ II) from 2008 through 2020. Data on prevalence, mortality, surgery, intestinal failure (IF), growth, and neurodevelopment at 2-year follow-up were separately analyzed for medically and surgically treated children. Results Of 3,456 preterm infants, 200 (6%) were diagnosed with NEC, of whom 135 developed an indication for surgery within 7 days after the diagnosis; 28/135 died before surgery, and 37/107 died after an open-and-close procedure. An enterostomy was constructed in 62 patients and an end-to-end anastomosis in 15. The postoperative course was described for 77 patients, of whom 23 developed surgical complications (12/23 incisional hernias, 9/23 anastomotic strictures), 13/77 a short bowel, and 25/77 IF. Sixty-day survival after birth for medical NEC patients was 88% (hazard ratio [HR]: 0.698; p = 0.318), and for surgically treated NEC patients was 40% (HR: 3.729; p < 0.001). At 2-year follow-up, one patient received parenteral nutrition. Severe delay in weight for age, motor, and cognitive development was seen in 3, 6, and 2%, respectively. Conclusion In this cohort, the mortality rate was high, especially in surgically treated NEC patients. The surgical complication rate is comparable to previous studies, but in surviving patients, persisting IF and severe delay in growth and neurodevelopment at 2 years CA were relatively rare.

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Nomogram for predicting fulminant necrotizing enterocolitis

Zhang

et al. 2023

Pediatr Surg Int

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Background Fulminant necrotizing enterocolitis (FNEC) is the most serious subtype of NEC and has a high mortality rate and a high incidence of sequelae. Onset prediction can help in the establishment of a customized treatment strategy. This study aimed to develop and evaluate a predictive nomogram for FNEC. Methods We conducted a retrospective observation to study the clinical data of neonates diagnosed with NEC (Bell stage ≥ IIB). Neonates were divided into the FNEC and NEC groups. A multivariate logistic regression model was used to construct the nomogram model. The performance of the nomogram was assessed using area under the curve, calibration analysis, and decision curve analysis. Results A total of 206 neonate cases were included, among which 40 (19.4%) fulfilled the definition of FNEC. The identified predictors were assisted ventilation after NEC onset; shock at NEC onset; feeding volumes before NEC onset; neutrophil counts on the day of NEC onset; and neutrophil, lymphocyte, and monocyte counts on day 1 after NEC onset. The nomogram exhibited good discrimination, with an area under the receiver operating characteristic curve of 0.884 (95% CI 0.825–0.943). The predictive model was well calibrated. Decision curve analysis confirmed the clinical usefulness of this nomogram. Conclusion A nomogram with a potentially effective application was developed to facilitate the individualized prediction of FNEC, with the hope of providing further direction for the early diagnosis of FNEC and timing of intervention.

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Effect of Feeding Strategies on the Development of Fulminant Necrotizing Enterocolitis

Cited by 4 publications

References 12 publications

Predictive factors for rapid progression in preterm neonates with necrotizing enterocolitis

Predictive factors for rapid progression in preterm neonates with necrotizing enterocolitis

Necrotizing Enterocolitis in a Dutch Cohort of Very Preterm Infants: Prevalence, Mortality, and Long-Term Outcomes

Nomogram for predicting fulminant necrotizing enterocolitis

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