Necrotizing enterocolitis prophylaxis: oral antibiotics and lyophilized enterobacteria vs oral immunoglobulins

Fast, Ch; Rosegger, H

doi:10.1111/j.1651-2227.1994.tb13253.x

Cited by 27 publications

(9 citation statements)

References 33 publications

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“…Premature infants have decreased levels of immunoglobulins, especially secretory IgA [17]. In a randomized clinical trial, Eibl et al [16] evaluated the efficacy of an oral immunoglobulin preparation (73% IgA and 26% IgG) in reducing the incidence of NEC in infants of low birth weight for whom breast milk from their mothers was not available.…”

Section: Immunoglobulinsmentioning

confidence: 98%

“…However, other authors have failed to reproduce the data, they failed to show a decrease in the incidence of NEC by using oral immunoglobulins. In a prospective randomized trial, Fast et al [17] compared the efficacy of oral gentamycin versus oral IgA-IgG for the prophylaxis of NEC. NEC was diagnosed in 13 cases in the oral IgA-IgG group of 100 infants compared with one case in the oral gentamycin group of 100 infants.…”

Section: Immunoglobulinsmentioning

confidence: 99%

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Multi-modal approach to prophylaxis of necrotizing enterocolitis: clinical report and review of literature

et al. 2006

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For the first time a multimodal approach to NEC prophylaxis is reported, consisting of early trophic feeding with human breast milk, and enteral administration of an antibiotic, an antifungal agent, and probiotics. A retrospective analysis of local protocol of NEC prophylaxis is presented. Included were all VLBWI admitted to the NICU, including transfers within the first 28 days of life. These infants were divided into two groups, an "inborn group" (infants admitted within the first 24 h of life) and an "outborn group" (infants admitted after the onset of their second day of life). Prophylaxis of NEC according to protocol was started at the day of admission, and was continued until discharge. Between 1998 and 2004, 405 VLBWI were admitted, including all transfers within the first 28 days of life. A total of 334 (82%) infants were admitted within the first 24 h of life (inborn group), and 71 (18%) were admitted after 24 h of life (outborn group). Five infants developed clinical features of necrotizing enterocolitis. The inborn group showed a NEC incidence of 0.7% (two infants), whereas the outborn group showed a NEC incidence of 4.5% (three infants), respectively. This difference was significant (P=0.049, Fisher's exact test). A surgical treatment with bowel resection was performed in two infants (both from the outborn group). The present study used a combination of different strategies, all having shown to have some beneficial effect, but not having brought a clinical breakthrough in single administration studies. Combinated were the beneficial effects of human breast milk feeding, oral antiobiotics, oral antifungal agents, and the administration of probiotics. In a homogenous group of preterm infants, using this protocol of multimodal NEC prophylaxis, there was a very low incidence of NEC, when started within the first 24 h of life.

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Section: Immunoglobulinsmentioning

confidence: 98%

Section: Immunoglobulinsmentioning

confidence: 99%

Multi-modal approach to prophylaxis of necrotizing enterocolitis: clinical report and review of literature

et al. 2006

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“…Premature infants have decreased levels of immunoglobulins, especially secretory IgA [192] . A reduction in the incidence of NEC following feeding an oral IgA-IgG preparation was reported as early as 1988 [190] .…”

Section: Oral Immunoglobulinsmentioning

confidence: 99%

Necrotizing enterocolitis: A multifactorial disease with no cure

Schnabl

Aerde²,

Thomson³

et al. 2008

WJG

160

120

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INTRODUCTIONNecrotizing enterocolitis (NEC) is an inflammatory bowel disease of neonates and remains one of the most common gastrointestinal emergencies in newborn infants [1] . Onset of NEC is often within the first three months of life and neonates who are of extremely low birth weight (< 1000 g) and under 28 wk gestation are the most susceptible [2] . Full term neonates account for 10% of all NEC cases while premature infants account for 90% [3] . With an incidence rate of 1%-5% for all newborns admitted to the NICU [1] , a prevalence of 7%-14% of very low birth weight infants (VLBW, 500-1500 g) [4] and a mortality rate approaching 20%-50% [5] , NEC continues to represent a significant clinical problem. In Canada, the incidence rate is 1.8 per 100 live births with a prevalence of 7% of VLBW infants [1] . Advances in obstetric and neonatal care have improved survival rates for smaller, more immature infants, and as more VLBW preterm infants survive the neonatal period, the population at risk for NEC increases [1] .No consistent association between sex, race, and rates of NEC has been identified. However, male VLBW infants and black infants are at greater risk of death [6] . Due to inadequate treatments and no effective preventative strategy, an estimated 20%-40% of babies with NEC require surgery [1] and 10%-30% experience significant morbidity including neurodevelopmental impairment, vision and hearing impairment, failure to thrive, feeding abnormalities, diarrhea, bowel obstruction, and short bowel syndrome [1,2,7] . The case fatality rate with surgical intervention is as high as 50% [1] . NEC is also a financial burden to the health care system with yearly hospital charges reported to be as high as $6.5 million in the US [8] . Thus, NEC continues to be an important health issue for preterm neonates. DIAGNOSIS Clinical signs and symptomsThe onset of NEC can occur suddenly within a few AbstractNecrotizing enterocolitis is an inflammatory bowel disease of neonates with significant morbidity and mortality in preterm infants. Due to the multifactorial nature of the disease and limitations in disease models, early diagnosis remains challenging and the pathogenesis elusive. Although preterm birth, hypoxic-ischemic events, formula feeding, and abnormal bacteria colonization are established risk factors, the role of genetics and vasoactive/inflammatory mediators is unclear. Consequently, treatments do not target the specific underlying disease processes and are symptomatic and surgically invasive. Breast-feeding is the most effective preventative measure. Recent advances in the prevention of necrotizing enterocolitis have focused on bioactive nutrients and trophic factors in human milk. Development of new disease models including the aspect of prematurity that consistently predisposes neonates to the disease with multiple risk factors will improve our understanding of the pathogenesis and lead to discovery of innovative therapeutics.

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“…In fact, bacterial colonization may be a prerequisite for the development of NEC. Common bacterial isolates from blood and peritoneal and stool cultures from infants with advanced NEC include E. coli, Enterobacter [90], Klebsiella species, and occasionally, coagulase-negative Staphylococcus species [91,92]. Other organisms that have been isolated include Streptococcus and Lactobacillus.…”

Section: Role Of Bacteria In the Pathogenesis Of Necmentioning

confidence: 99%

Role of the Host Defense System and Intestinal Microbial Flora in the Pathogenesis of Necrotizing Enterocolitis

Emami

Petrosyan

Giuliani

et al. 2009

Surgical Infections

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Background: Necrotizing enterocolitis (NEC) is a devastating disease that affects primarily the intestine of premature infants. Despite recent advances in neonatology, NEC remains a major cause of morbidity and mortality in neonates. Neonatal mucosal defenses and adherence of bacterial pathogens may play an important role in the pathogenesis of NEC. Methods: Review and synthesis of pertinent literature. Results: Putative factors that have been implicated in the pathogenesis of NEC include abnormal patterns of gut colonization by bacteria, immaturity of the host immune system and mucosal defense mechanisms, intestinal ischemia, formula feeding, and loss of intestinal epithelial barrier integrity. Conclusion: Host defenses and intestinal microbial ecology are believed to play important roles in the pathogenesis of NEC. Commensal bacteria and probiotic therapy may be of therapeutic utility in the maintenance of the gut epithelial barrier.

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Necrotizing enterocolitis prophylaxis: oral antibiotics and lyophilized enterobacteria vs oral immunoglobulins

Cited by 27 publications

References 33 publications

Multi-modal approach to prophylaxis of necrotizing enterocolitis: clinical report and review of literature

Multi-modal approach to prophylaxis of necrotizing enterocolitis: clinical report and review of literature

Necrotizing enterocolitis: A multifactorial disease with no cure

Role of the Host Defense System and Intestinal Microbial Flora in the Pathogenesis of Necrotizing Enterocolitis

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