Major Contributors to Hospital Mortality in Very-Low-Birth-Weight Infants: Data of the Birth Year 2010 Cohort of the German Neonatal Network

Stichtenoth, Guido; Demmert, Martin; Bohnhorst, Bettina; Stein, Anja; Ehlers, Silke; Heitmann, Friedhelm; Rieger‐Fackeldey, Esther; Olbertz, Dirk; Roll, Claudia; Emeis, Michael; Mögel, Michael; Schiffmann, Holger; Wieg, Christian; Wintgens, Jürgen; Herting, Egbert; Göpel, Wolfgang; Härtel, Christoph

doi:10.1055/s-0032-1306344

Cited by 57 publications

(45 citation statements)

References 7 publications

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“…Consequently, it can be assumed that other factors besides a reduction of NEC improved the survival in these infants. NEC, severe IVH, and sepsis are major contributors to death among VLBW infants (27). The reduction of mortality in our study-as it can be explained from our data-is caused by the reduction of NEC and severe IVH that was statistically significant as a compound outcome-as well as improvements in sepsis management.…”

Section: Discussionsupporting

confidence: 60%

Probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum) prevent NEC in VLBW infants fed breast milk but not formula

et al. 2014

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Background: Specific probiotics prevent necrotizing enterocolitis (NEC). A mixture of lactobacilli and bifidobacteria (Infloran) was highly effective in Asian very-low-birth-weight (VLBW) infants. We analyzed the effect of Infloran on NEC, NEC severity, and the influence of enteral feedings (breast milk vs. formula) on NEC prevention in a cohort of European VLBW infants. Methods: Infloran was implemented for routine use at our department. VLBW infants receiving probiotics were prospectively followed (2010)(2011)(2012) and compared with historic controls (2008)(2009). Data on NEC, neonatal morbidity, feeding tolerance, and descriptive parameters on NEC cases were analyzed. results: Infloran had no statistically significant impact on NEC (controls: 24/233 (10.3%); probiotics: 16/230 (7%); P = 0.2). However, NEC was significantly reduced in infants of the probiotics group who were fed any breast milk (20/179 (11.2%) vs. 10/183 (5.5%); P = 0.027), whereas it was ineffective in infants exclusively fed formula (4/54 (7.4%) vs. 6/44 (13.6%); P = 0.345). Occurrence of severe NEC (IIIb), time until full feeds, and gastric residuals were similar. conclusion: Infloran was of lower efficacy in a European VLBW cohort and showed a reduction of NEC only in infants fed breast milk. Future studies should investigate the influence of feeding formula or breast milk on the effect of probiotics.n ecrotizing enterocolitis (NEC) is an important cause of mortality and morbidity in premature infants (1). Although its pathogenesis is incompletely understood, a relation to an immature intestinal barrier, aberrant bacterial colonization, and enteral feedings is well established (2). Due to the seriousness of the disease, preventive strategies like the use of human milk and standardized feeding protocols (3-5) are of highest interest.Probiotics are microorganisms that confer a health benefit after ingestion (6). They are generally regarded as safe, and only single cases of sepsis were described in patients with major comorbidities (7). In preterm infants, probiotics may act beneficially by improving the intestinal barrier (8) and promoting a healthy gut microflora (9). Furthermore, they exert antiinflammatory effects on the gut epithelium (10) and improve local and systemic immune responses (11) that may strengthen a preterm infant's still immature immune defense. In the recent past, a preventive effect against NEC was assumed (12), and a variety of probiotic preparations were studied in randomized trials. Meta-analyses of these trials reported on a reduction of NEC in very-low-birth-weight (VLBW) infants by 65% (13,14), and the use of probiotics in clinical routine was recommended. Based on these suggestions, we decided to introduce probiotics for NEC prophylaxis as standard of care at our department. The probiotic preparation Infloran (Laboratorio Farmaceutico, Mede, Italia) consists of a mixture of Lactobacillus acidophilus and Bifidobacterium infantis and was chosen as its use was suggested by European experts (14) and it was available ...

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Section: Discussionsupporting

confidence: 60%

Probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum) prevent NEC in VLBW infants fed breast milk but not formula

et al. 2014

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“…The main clinical risk factors that have been identified include degree of prematurity, pre- and postnatal infections, postnatal asphyxia, intrauterine growth retardation, and male gender [1,2,3,4]. …”

Section: Potential Risks and Benefits Of High-dose Vitamin A Supplemementioning

confidence: 99%

“…Bronchopulmonary dysplasia (BPD) affects as many as 35% of extremely low birth weight infants (ELBW; birth weight <1,000 g) [1,2,3,4]. BPD is defined as the need for oxygen supplementation at 36 weeks' postmenstrual age (PMA) [5].…”

Section: Introductionmentioning

confidence: 99%

Early Postnatal Additional High-Dose Oral Vitamin A Supplementation versus Placebo for 28 Days for Preventing Bronchopulmonary Dysplasia or Death in Extremely Low Birth Weight Infants

2014

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Background: Prematurity and the associated risk for bronchopulmonary dysplasia (BPD) remain a significant threat to extremely low birth weight (ELBW) infants. Vitamin A has been considered a therapeutic alternative in reducing the rate of BPD and mortality. Objectives: To investigate whether early postnatal, additional high-dose oral vitamin A supplementation for 28 days is more efficient in reducing BPD or death in ELBW infants than placebo treatment. Methods: This is a multicenter, double-blind RCT comparing postnatal high-dose oral vitamin A supplementation (5,000 IU vitamin A/kg/day vs. placebo) for 28 days in ELBW neonates requiring mechanical ventilation, noninvasive ventilatory support or supplemental oxygen at 24 h of age. The primary end point is the proportion of children who died before 36 weeks' gestational age or developed moderate or severe BPD. BPD is defined as the need for supplemental oxygen to maintain SaO₂ of ≥92% at rest at 36 weeks' postmenstrual age (PMA). Clinical secondary end points include the following: BPD (including mild form), intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, necrotizing enterocolitis, total number of days of mechanical ventilation and oxygen supplementation, and safety and tolerability of high-dose vitamin A supplementation. Results and Conclusions: The results of the NeoVitaA trial will provide robust data with regard to the efficacy of high-dose oral vitamin A supplementation in reducing the incidence of BPD or death at 36 weeks' PMA in ELBW infants.

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“…508 (80 %) of them were admitted on the fi rst, 80 (13 %) on days 2 + 3 and 47 (7 %) from day 4 until day 10 of life. The median birth weight was 2 440 g (range 374-5 000), the median gestational age 36 weeks (range[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]). The median length of stay was 14 days (range 1-264).…”

mentioning

confidence: 99%

Colonization and Infection due to Multi-resistant Bacteria in Neonates: A Single Center Analysis

Haase

Worlitzsch²,

Schmidt

et al. 2013

Klin Padiatr

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▼ Background: In the last years the prevalence of multi-resistant pathogens (MRPs) has increased. Systemic infections remain important for neonatal morbidity and mortality. Patients: Neonates born between January 2011 and December 2012 and admitted to the neonatology before their tenth day of life were included into this retrospective analysis. Vancomycinresistant Enterococci, Methicillin-resistant Staphylococcus aureus, Gram-negative bacilli with Extend Spectrum Beta Lactamase or AMP-C resistance were defi ned as multi-resistant pathogens (MRPs). MRP positive and negative patients were analyzed regarding clinical risk factors and the incidence of systemic infections. Results: 635 neonates were admitted during the analysis period. In 31 patients MRPs were detected. 2 patients developed MRP-associated infections. Both were discharged without long term health risks. Low gestational age and need for mechanical ventilation were risk factors for colonization with MRPs in the univariat analysis. The incidence density (per 1 000 patient days) for all MRE increased from 0.76 in 2011 to 3.51 in 2012. In contrast the sepsis rate remained stable (14.9 % and 14.2 %). 2 MRP colonization clusters were detected by routine microbiology swabs. Both could be controlled by appropriate hygienic measures. Conclusions:The prevalence of Gram-negative MRPs increased in neonates. Microbiological screening seems to be helpful for early detection of colonization and thus prevention of nosocomial infections with MRPs. Despite the increased attention towards the problems associated with multiresistant bacteria, there are still major eff orts needed for prevention and early treatment of sepsis with non-resistant bacteria.

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Major Contributors to Hospital Mortality in Very-Low-Birth-Weight Infants: Data of the Birth Year 2010 Cohort of the German Neonatal Network

Cited by 57 publications

References 7 publications

Probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum) prevent NEC in VLBW infants fed breast milk but not formula

Probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum) prevent NEC in VLBW infants fed breast milk but not formula

Early Postnatal Additional High-Dose Oral Vitamin A Supplementation versus Placebo for 28 Days for Preventing Bronchopulmonary Dysplasia or Death in Extremely Low Birth Weight Infants

Colonization and Infection due to Multi-resistant Bacteria in Neonates: A Single Center Analysis

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