Neonatal rotavirus-associated necrotizing enterocolitis: Case control study and prospective surveillance during an outbreak

Abstract

After the death of a premature infant from rotavirus-associated necrotizing enterocolitis, we instituted prospective surveillance for this disease in our neonatal intensive care unit. During the 4-month study period an additional six cases of necrotizing enterocolitis and eight cases of hemorrhagic gastroenteritis occurred. Rotavirus infection was documented in 11 of these 15 symptomatic infants, in comparison with only eight rotavirus infections in 147 asymptomatic or minimally symptomatic babies (P less than 0.0001). Stools from 110 nursery personnel tested during the outbreak did not contain rotavirus. However, 12 of 59 staff members had serum IgM antibody against rotavirus, suggesting recent infection. In a case-control study we compared babies with severe gastrointestinal illness with a control group randomly selected from asymptomatic babies in the nursery during the time of the outbreak. Univariate analysis found six categorical variables and nine continuous variables that were significantly associated with disease. Multivariate logistic regression analysis, however, found only birth weight (P less than 0.0001), rotavirus infection (P less than 0.0001), and age at time of first nonwater feeding (P less than 0.02) to be associated with gastrointestinal illness. This study provides further evidence for the role of infection in some cases of neonatal necrotizing enterocolitis and hemorrhagic gastroenteritis.

Occurrence of Necrotizing Enterocolitis May Be Dependent on Patterns of Bacterial Adherence and Intestinal Colonization: Studies in Caco-2 Tissue Culture and Weanling Rabbit Models

“…Epidemics of NEC have been associated with single pathogens such as E. coli, Enterobacter cloacae, K. pneumoniae, Salmonella spp, S. epidemidis, Clostridium butyricum, C. dificile, corona virus, enterovirus, and rotavirus (2,(5)(6)(7)(8)(9)(10). Although these outbreak reports have generated interest in the role of specific microorganisms in NEC, they may not be representative of "normal" endemic NEC in neonatal nurseries.…”

“…The etiology of NEC is unknown. Although there have been outbreaks of NEC associated with specific infectious agents (2,(5)(6)(7)(8)(9)(10), the range of agents isolated is broad, and in studies of endemic disease it has not been possible to consistently link a single infectious agent with illness (11).…”

Rice-based oral antibody fragment prophylaxis and therapy against rotavirus infection

“…The lag time between vaccine administration and induction of an immune response, as well as poor efficacy in immunocompromised individuals, can be critical in highly endemic regions and outbreak situations, such as those occurring in hospital settings (15)(16)(17)(18). Furthermore, severely immunocompromised individuals do not mount protective immunity when infected with RV and thus suffer chronic infection (19)(20)(21)(22), which can subsequently lead to extraintestinal spread with severe clinical consequences (19)(20)(21).…”

Duodenal perforation in an infant with rotavirus gastroenteritis

“…However, worldwide it is estimated that rotavirus infections are responsible for half a million annual deaths in children, primarily related to acute severe dehydration. Rotavirus-related deaths are also reported in European countries, most frequently among infants3 and in neonates with rotavirus-associated necrotising enterocolitis 4 5…”