Emerging trends in acquired neonatal intestinal disease: is it time to abandon Bell's criteria?

Gordon, P V; Swanson, Jonathan R.; Attridge, J T; Clark, Reese H.

doi:10.1038/sj.jp.7211782

Cited by 172 publications

(169 citation statements)

References 64 publications

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“…18 Although NEC and SIP occur in the same population of infants, SIP occurs earlier between 4 to 14 days of age, with a peak incidence between 6 to 9 days and occurs more often in smaller and more immature infants. 14,17,18 The clinical characteristics of infants treated with ibuprofen and who developed SIP were similar to those described previously. 15,17,19,20 Infants in our study with bowel perforation were also of younger GA, had lower birth weight and developed perforation towards the end of first week of life.…”

Section: Discussionsupporting

confidence: 56%

“…14,17,18 The clinical characteristics of infants treated with ibuprofen and who developed SIP were similar to those described previously. 15,17,19,20 Infants in our study with bowel perforation were also of younger GA, had lower birth weight and developed perforation towards the end of first week of life. All infants were treated with surgical drainage with spontaneous healing of the perforation.…”

Section: Discussionsupporting

confidence: 56%

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Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus

Rao

Bryowsky

Mao³

et al. 2011

J Perinatol

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Objective: To review intestinal complications associated with ibuprofen treatment of patent ductus arteriosus (PDA).Study Design: Data from preterm infants treated with ibuprofen were retrospectively reviewed. w 2 test and Fischer's exact test were used for univariate analyses. Multivariate analyses with logistic regression modeling were used to identify risk factors.Result: One hundred and two infants were treated with ibuprofen for PDA. Nine (9/102, 8.8%) infants developed spontaneous intestinal perforation (SIP), whereas 93/102 (91.2%) did not. The mean (±s.d.) gestational age (GA) at birth in infants with and without SIP was 25.2 ( ± 1.3) vs 27.6 ( ± 2.4) weeks (P ¼ 0.02) and the median (interquartile) length of stay (LOS) was 109.5 (91.0 to 116.5) vs 75.0 (53.0 to 94.5) days (P ¼ 0.002), respectively. The mean ( ± s.d.) age at starting ibuprofen was 3.3 ( ± 1.3) vs 5.8 (±3.5) days in infants with and without SIP, respectively (P ¼ 0.03). In logistic regression analyses, increasing GA and later initiation of ibuprofen treatment were protective against risk of SIP; odds ratio, 95% confidence interval (OR, 95% CI) ¼ 0.26 (0.09 to 0.75), P ¼ 0.01 and 0.63 (0.41 to 0.95), P ¼ 0.03, respectively.Conclusion: Infants at lower GA are at risk of SIP when treated early with ibuprofen for symptomatic PDA.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionsupporting

confidence: 56%

Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus

Rao

Bryowsky

Mao³

et al. 2011

J Perinatol

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“…If a patient had focal gastrointestinal perforation, based on visual inspection of the bowel at the time of surgery, the condition was not listed as NEC but as spontaneous intestinal perforation (SIP). We note that while our methods of distinguishing NEC from SIP are not fully consistent with the guidelines recently proposed by Gordon et al, 8 who pointed out that pneumoperitoneum without pneumatosis would be categorized as NEC if treated by abdominal drainage under the Vermont Oxford Network definitions, all infants with pneumoperitoneum receive laparotomy within our system, thereby circumventing this diagnostic pitfall.…”

Section: Methodsmentioning

confidence: 68%

Necrotizing enterocolitis during the first week of life: a multicentered case–control and cohort comparison study

et al. 2008

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Objective: Necrotizing enterocolitis (NEC) is rare during the first week of life; most cases occur after 2 to 4 weeks. We hypothesized that when NEC develops in the first week, certain predisposing factors and feeding practices are identifiable. To test this, we sought to identify every case of NEC diagnosed during the first week within the Intermountain Healthcare system during the most recent 6-year period.Study Design: Data were collected from neonates admitted to any Intermountain Healthcare neonatal intensive care unit (NICU) with a date of birth from 1 January 2001 through 31 December 2006. Electronic and paper records were obtained for all with a diagnosis of NEC (Bell stage XII) within the first 168 h. X-rays, physician notes, nursing records, laboratory reports and operative reports were subjected to critical review to reexamine the diagnosis of NEC. Among those with confirmed NEC, we recorded underlying conditions and every feeding given prior to the diagnosis of NEC. Comparisons were made with patients that did not develop NEC, yet were cared for in the same NICUs, during the same period of time, and of the same gestational ages.Result: A total of 28 neonates were identified electronically as having NEC during the first week. Critical review confirmed this in 21, but 5 were determined at laparotomy to have had spontaneous intestinal perforation, and 2 others were found on surgical reports to have had a congenital infarction of the colon. Total 20 of the 21 confirmed cases developed NEC while in a NICU being treated for another condition. The exception was a small-for-gestational-age neonate in a well baby nursery. Compared to 6100 controls, the 21 with early NEC were more likely to have had a meconium-positive test for illicit drug exposure (P<0.005), early onset sepsis (P<0.034) and respiratory distress (P<0.039). They were less likely than case-controls to have been fed human milk (P ¼ 0.003) and were more likely to have been fed formula exclusively (P ¼ 0.019).None who were fed human milk exclusively developed early NEC. Twelve of the twenty-one were fed (by gavage or bottle) amounts exceeding the upper limit of volumes taken by breastfed neonates. Conclusion:We speculate that the prevalence of NEC during the first week could be reduced by identifying at-risk patients, feeding them human milk exclusively for the first week and using feeding volumes that do not exceed that taken by healthy breastfed neonates.

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“…3 Our infants with SIP fell into the late onset category (acquiring SIP on average between 7 and 10 DOL) 2 related to known postnatal risk factors 3,4 such as exposure to indomethacin and glucocorticoids, presence of a PDA and use of vasoactive pressors within 14 days of perforation.…”

Section: Discussionmentioning

confidence: 99%

Long-distance air medical transport of extremely low birth weight infants with pneumoperitoneum

et al. 2008

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Objective: Long-distance air transport (LDAT) of infants with pneumoperitoneum for pediatric surgical evaluation has not been previously reported. We examined whether extremely low birth weight (ELBW) infants with and without pneumoperitoneum would tolerate transport differently.Study Design: A retrospective cohort study was conducted comparing ELBW infants diagnosed with pneumoperitoneum to other ELBW infants transported >2000 miles by a trained team from a US Department of Defense tertiary care neonatal intensive care unit in Okinawa, Japan.Result: Between 2000 and 2006, 49 air transports met study criteria. Seven of the 49 (14%) infants had pneumoperitoneum at time of transport. The average distance flown was 5346 miles per transport. The 49 infants had a median gestational age of 25 weeks and birth weight of 761 ± 127 g. ELBW infants without pneumoperitoneum were transported at a median 58 days of life (DOL; range 30 to 91 days) compared to infants with pneumoperitoneum, who were transported at a median 8 DOL (range 6 to 14 days). At the time of LDAT, infants with pneumoperitoneum were significantly smaller, receiving more arterial and central venous access, more pressors for hypotension, and more mechanical ventilation compared to ELBW infants transported without pneumoperitoneum. In-flight patient-related medical issues were similar regardless of underlying diagnosis or age at the time of transport.Conclusion: Successful LDAT of ELBW infants, including critically ill infants with intestinal perforation, is possible. Use of personnel, experienced and trained in aviation transport physiology, overcomes the extreme physiologic operating environment associated with LDATs.

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Emerging trends in acquired neonatal intestinal disease: is it time to abandon Bell's criteria?

Cited by 172 publications

References 64 publications

Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus

Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus

Necrotizing enterocolitis during the first week of life: a multicentered case–control and cohort comparison study

Long-distance air medical transport of extremely low birth weight infants with pneumoperitoneum

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