Neurodevelopmental outcomes following necrotizing enterocolitis

Hickey, Marie; Georgieff, Michael; Ramel, Sara E.

doi:10.1016/j.siny.2018.08.005

Cited by 70 publications

(66 citation statements)

References 45 publications

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“…Indeed, in their extremely low gestational age newborn cohort, Martin et al [49] demonstrated that risks of neurodevelopmental impairment were higher in infants with surgically treated NEC and concurrent sepsis. NEC is also associated with other complications of prematurity, including mechanical ventilation, bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity, which affect neurocognitive outcome [3]. …”

Section: Neurodevelopment In Survivors Of Necmentioning

confidence: 99%

“…The association between NEC and neurodevelopment is most likely multifactorial, with different insults accompanying the intestinal manifestations of NEC. The specific type, severity, and duration of these insults will determine the specific locations of brain injury and outcomes [3, 21]. …”

Section: Neurodevelopment In Survivors Of Necmentioning

confidence: 99%

“…The cytokines which are produced by this process may disrupt development of the vulnerable preterm brain [3]. Volpe [55] demonstrated that in the process of encephalopathy the premyelinating oligodendrocyte is very vulnerable to ischemia and inflammation.…”

Section: Neurodevelopment In Survivors Of Necmentioning

confidence: 99%

“…NEC is associated with a mortality rate of between 15 and 30% [1, 2]. Survivors of NEC often have life-long consequences, such as short-bowel syndrome and impaired neurological outcome [3]. The pathophysiology is not clear but is considered to be multifactorial.…”

Section: Introductionmentioning

confidence: 99%

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Necrotizing Enterocolitis, Gut Microbiota, and Brain Development: Role of the Brain-Gut Axis

et al. 2019

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Necrotizing enterocolitis (NEC) is a relatively common disease in very-low-birth-weight infants and is associated with high mortality and morbidity. In survivors, neurodevelopmental impairment is frequently seen. The exact etiology remains largely to be elucidated, but microbiota are considered to play a major role in the development of NEC. Furthermore, emerging evidence exists that the microbiota is also of importance in brain function and development. Therefore, microbiota characterization has not only potential as a diagnostic or even preventive tool to predict NEC, but may also serve as a biomarker to monitor and possibly even as a target to manipulate brain development. Analysis of fecal volatile organic compounds, which shape the volatile metabolome and reflect microbiota function and host interaction, has been shown to be of interest in the diagnosis of NEC and late-onset sepsis. In this review, we discuss evidence of the role of the complex interplay between microbiota, NEC, and brain development, including the brain-gut axis in preterm infants.

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Section: Neurodevelopment In Survivors Of Necmentioning

confidence: 99%

Section: Neurodevelopment In Survivors Of Necmentioning

confidence: 99%

Section: Neurodevelopment In Survivors Of Necmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Necrotizing Enterocolitis, Gut Microbiota, and Brain Development: Role of the Brain-Gut Axis

et al. 2019

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“…These are now the commonest causes of acute morbidity and death beyond the early neonatal period for very preterm infants [1]. Infants who develop severe NEC or infection have longer durations of hospital stay than age-equivalent infants without these conditions, and they are more likely to develop bronchopulmonary dysplasia or be diagnosed with neurological impairment or disability with consequent higher (life-long) health service needs and costs [4, 5] (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

Immunonutrition for Preterm Infants

Walsh

McGuire²

2019

Neonatology

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Care and outcomes for very preterm infants continue to improve, but important causes of mortality and acute and long-term morbidity associated with prolonged hospitalisation remain. Necrotising enterocolitis (NEC) and late-onset infection have emerged as the major causes of death beyond the early neonatal period and of neurodisability in very preterm infants. Although the pathogenesis of these conditions is incompletely understood, it appears to be related to the content and mode of delivery of the enteral diet, particularly the impact of immunonutrients from human breast milk on the microbial and metabolic balance within the immature intestine. Evidence exists to support investment in measures to help mothers to express breast milk as the primary source of nutrition for their very preterm infants. In the absence of maternal milk, pasteurised donor breast milk provides protection against NEC, but its nutritive adequacy is not clear and its cost-effectiveness is uncertain. Supplementation with individual immunonutrients, including immunoglobulins and lactoferrin, has not been shown to be effective in preventing NEC or infection in randomised controlled trials. The evidence base for prebiotics and probiotics is stronger, but concerns exist about the choice, safety and availability of formulations. Other strategies – including avoidance of drugs such as gastric acid suppressants that compromise innate immunity, as well as evidence-based progressive feeding strategies that reduce exposure to invasive interventions – are emerging as key components of care packages to reduce the burden of NEC, infection and associated growth and developmental faltering for very preterm infants.

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Association of Blood Donor Sex and Age With Outcomes in Very Low-Birth-Weight Infants Receiving Blood Transfusion

et al. 2021

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IMPORTANCE There are conflicting data on the association between blood donor characteristics and outcomes among patients receiving transfusions.OBJECTIVE To evaluate the association of blood donor sex and age with mortality or serious morbidity in very low-birth-weight (VLBW) infants receiving blood transfusions. DESIGN, SETTING, AND PARTICIPANTSThis is a cohort study using data collected from 3 hospitals in Atlanta, Georgia. VLBW infants (Յ1500 g) who received red blood cell (RBC) transfusion from exclusively male or female donors were enrolled from January 2010 to February 2014. Infants received follow-up until 90 days, hospital discharge, transfer to a non-study-affiliated hospital, or death. Data analysis was performed from July 2019 to December 2020.EXPOSURES Donor sex and mean donor age. MAIN OUTCOMES AND MEASURESThe primary outcome was a composite outcome of death, necrotizing enterocolitis (Bell stage II or higher), retinopathy of prematurity (stage III or higher), or moderate-to-severe bronchopulmonary dysplasia. Modified Poisson regression, with consideration of covariate interactions, was used to estimate the association between donor sex and age with the primary outcome, with adjustment for the total number of transfusions and birth weight. RESULTSIn total, 181 infants were evaluated, with a mean (SD) birth weight of 919 (253) g and mean (SD) gestational age of 27.0 (2.2) weeks; 56 infants (31%) received RBC transfusion from exclusively female donors. The mean (SD) donor age was 46.6 (13.7) years. The primary outcome incidence was 21% (12 of 56 infants) among infants receiving RBCs from exclusively female donors, compared with 45% (56 of 125 infants) among those receiving RBCs from exclusively male donors. Significant interactions were detected between female donor and donor age (P for interaction = .005) and between female donor and number of transfusions (P for interaction < .001). For the typical infant, who received a median (interquartile range) of 2 (1-3) transfusions, RBC transfusion from exclusively female donors, compared with male donors, was associated with a lower risk of the primary outcome (relative risk, 0.29; 95% CI, 0.16-0.54). The protective association between RBC transfusions from female donors, compared with male donors, and the primary outcome increased as the donor age increased, but decreased as the number of transfusions increased. CONCLUSIONS AND RELEVANCEThese findings suggest that RBC transfusion from female donors, particularly older female donors, is associated with a lower risk of death or serious morbidity in VLBW infants receiving transfusion. Larger studies confirming these findings and examining potential mechanisms are warranted.

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Neurodevelopmental outcomes following necrotizing enterocolitis

Cited by 70 publications

References 45 publications

Necrotizing Enterocolitis, Gut Microbiota, and Brain Development: Role of the Brain-Gut Axis

Necrotizing Enterocolitis, Gut Microbiota, and Brain Development: Role of the Brain-Gut Axis

Immunonutrition for Preterm Infants

Association of Blood Donor Sex and Age With Outcomes in Very Low-Birth-Weight Infants Receiving Blood Transfusion

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