Necrotising enterocolitis hospitalisations among neonates in the United States

Holman, Robert C.; Stoll, Barbara J.; Curns, Aaron T.; Yorita, Krista L.; Steiner, Claudia; Schonberger, Lawrence B.

doi:10.1111/j.1365-3016.2006.00756.x

Cited by 311 publications

(213 citation statements)

References 15 publications

(76 reference statements)

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“…Although believed to be multifactorial, the exact mechanism of its development is not fully understood, and its incidence has not changed substantially over time. 75 It affects around 7% of neonates with BW 500-1,500 g, and 11.5% in the subgroup of ≤750 g. 76 Mortality varies between 20% and 30%, and it is higher in patients requiring surgery. 77,78 Evidence relating CA to NEC is not consistent, but several studies, summarized in the meta-analysis of Been et al, 79 support that CCA is significantly associated with NEC (odds ratio [OR] 1.24, 95% CI 1.01-1.52; P=0.04), as well as HCA with fetal involvement (OR, 3.29; 95% CI, 1.87-5.78; P≤0.001).…”

Section: Necrotizing Enterocolitismentioning

confidence: 99%

Chorioamnionitis and neonatal morbidity: current perspectives

Henríquez¹,

Rodrigo²

2017

RRN

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Abstract:The term chorioamnionitis (CA) is commonly used to refer to different clinical or pathological conditions characterized by an infectious and/or inflammatory process that affects primarily the chorioamniotic membranes, but also the amniotic fluid, vessels of the chorionic plate, and, eventually, the umbilical cord (funisitis) and the fetus. Its incidence is higher at lower gestational ages, and the main mechanism is believed to be the ascending bacterial infection from the maternal genital tract. It can be diagnosed by clinical criteria, amniotic fluid examination for inflammatory mediators, and/or isolation of microorganisms, or by histopathological examination of the placenta. CA is an important cause of stillbirth and is related to an increased incidence of premature rupture of membranes, preterm delivery, and adverse maternal and neonatal outcomes such as early-onset neonatal sepsis and necrotizing enterocolitis. An independent causal association to other neonatal morbidities is more controversial. The heterogeneity in the diagnostic criteria and in the operative definitions for morbidity makes comparison of studies difficult, and results are inconsistent. In addition, the intensity and duration of the process are usually not considered. For all these reasons, evidence-based recommendations for the management of mother and infant under these circumstances are difficult to establish, and clinical practice varies widely.

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Section: Necrotizing Enterocolitismentioning

confidence: 99%

Chorioamnionitis and neonatal morbidity: current perspectives

Henríquez¹,

Rodrigo²

2017

RRN

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“…It occurs in 1.1/1000 live births in the United States and accounts for 3 to 7.5% of all admissions to NICUs affecting 12 to 15% of all infants with birth weights <1500 g. [17][18][19] Rationale for studying progression to severe disease Despite more than 30 years of concentrated research efforts there are currently no effective interventions to prevent the development of NEC and its progression. Because we believed it important to understand why some infants with NEC recover uneventfully with medical therapy whereas others develop severe progressive disease, our collaborative committed to a prospective methodology with extensive clinical data collection in order to study disease progression in infants with NEC.…”

Section: Neonatal Factorsmentioning

confidence: 99%

Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study

et al. 2008

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Objective: Necrotizing enterocolitis (NEC) remains a major cause of neonatal morbidity and mortality. Some infants recover uneventfully with medical therapy whereas others develop severe disease (that is, NEC requiring surgery or resulting in death). Repeated attempts to identify clinical parameters that would reliably identify infants with NEC most likely to progress to severe disease have been unsuccessful. We hypothesized that comprehensive prospective data collection at multiple centers would allow us to develop a model which would identify those babies at risk for progressive NEC.Study Design: This prospective, observational study was conducted at six university children's hospitals. Study subjects were neonates with suspected or confirmed NEC. Comprehensive maternal and newborn histories were collected at the time of enrollment, and newborn clinical data were collected prospectively, thereafter. Multivariate logistic regression analysis was used to develop a predictive model of risk factors for progression.Result: Of 455 neonates analyzed, 192 (42%) progressed to severe disease, and 263 (58%) advanced to full feedings without operation. The vast majority of the variables studied proved not to be associated with progression to severe disease. A total of 12 independent predictors for progression were identified, including only 3 not previously described: having a teenaged mother (odds ratio, OR, 3.14; 95% confidence interval, CI, 1.45 to 6.96), receiving cardiac compressions and/or resuscitative drugs at birth (OR, 2.51; 95% CI, 1.17 to 5.48), and having never received enteral feeding before diagnosis (OR, 2.41; 95% CI, 1.08 to 5.52). Conclusion:Our hypothesis proved false. Rigorous prospective data collection of a sufficient number of patients did not allow us to create a model sufficiently predictive of progressive NEC to be clinically useful. It appears increasingly likely that further analysis of clinical parameters alone will not lead to a significant improvement in our understanding of NEC. We believe that future studies must focus on advanced biologic parameters in conjunction with clinical findings.

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“…The incidence of NEC is 6 to 10% among infants with birth weight less than 1500 g and varies among different US centers and across the world [2,3]. The disease is primarily seen in premature infants, however some term infants may also develop NEC.…”

Section: Epidemiologymentioning

confidence: 99%

Necrotizing Enterocolitis (NEC): A Devastating Disease of Prematurity

Garg¹,

Garg²,

Lal³

2015

J Neonatal Biol

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Necrotizing Enterocolitis (NEC) is a common and devastating gastrointestinal emergency that primarily affects premature infants. The incidence of necrotizing enterocolitis is 6-10% among infants with birth weight less than 1500 grams. The mortality due to NEC has not improved significantly despite advances in neonatal care and better understanding of clinical and basic sciences. The pathogenesis of NEC is not well understood and several factors such as prematurity, abnormal colonization with pathogenic bacteria, feeding practices, blood transfusion and altered intestinal barrier function may be involved. The clinical presentation of NEC could be sudden and the treatment plan could vary with the stage and type of presentation. Further research is needed to better understand the pathophysiology of NEC and, biomarkers for prediction, prevention and treatment need to be developed. Further clinical trials are needed to determine prevention and treatment modalities for this devastating disease.

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Necrotising enterocolitis hospitalisations among neonates in the United States

Cited by 311 publications

References 15 publications

Chorioamnionitis and neonatal morbidity: current perspectives

Chorioamnionitis and neonatal morbidity: current perspectives

Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study

Necrotizing Enterocolitis (NEC): A Devastating Disease of Prematurity

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