Predicting Mortality or Intestinal Failure in Infants with Surgical Necrotizing Enterocolitis

Bhatt, Darshna; Travers, Curtis; Patel, Ravi; Shinnick, Julia; Arps, Kelly; Keene, Sarah; Raval, Mehul V.

doi:10.1016/j.jpeds.2017.08.046

Cited by 17 publications

(17 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It affects 5-14% of infants weighing o1,500g (1). Among common neonatal gastrointestinal urgencies, NEC is highly lifethreatening, with a high mortality if not treated in due course (2)(3)(4)(5)(6). So far, the etiology of NEC is still multifactorial (7,8).…”

Section: ' Introductionmentioning

confidence: 99%

Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis

Gao

Mao

et al. 2021

Clinics

View full text Add to dashboard Cite

OBJECTIVE: This study aimed to identify the most useful ultrasound (US) features associated with definite neonatal necrotizing enterocolitis (NEC) and their prognostic values, particularly the calculated markers combined with important features. METHODS: A total of 213 suspected NEC cases were collected from the neonatal department of our hospital from January 2015 to August 2017. Each infant received both X-ray and US examinations. RESULTS: No differences were found in sex composition and delivery modes between groups. NEC-positive neonates had poorer prognosis compared to negative ones. The NEC group showed a higher frequency of abnormal signals. US showed higher NEC-related frequencies in different parameters. A variable (named predictor in US [PUS]) with five features was constructed. For NEC diagnosis, this variable provided a much higher area under the curve Q2 (AUC) (0.965) than other parameters. In this model, PUS had a cutoff value of 0.376 with a 0.900 sensitivity and 0.922 specificity. In prognosis, the closest factors were selected to draw a receiver operating characteristic curve, as well as a novel calculated variable US prognostic (USPro) marker. USPro had a much higher AUC (0.86) than other single features and showed a cutoff value of 0.18145, with 0.75 sensitivity and 0.84 specificity. This variable had a weaker power in prognosis when compared with PUS in diagnosis. CONCLUSIONS: The application of abdominal color Doppler US can provide high accuracy and sensitivity in NEC diagnosis and also contribute to its prognosis, without induction of radiation. Suspected neonates should be examined using this technique as early as possible.

show abstract

Section: ' Introductionmentioning

confidence: 99%

Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis

Gao

Mao

et al. 2021

Clinics

View full text Add to dashboard Cite

show abstract

“…Furthermore, a high mortality rate of around 30% is observed in infants with NEC-related bowel perforation [7][8][9]. Apgar score at 1 min, need of inotropic treatment, mean blood pressure, and late-onset sepsis are demonstrated predictors for mortality in surgical NEC [10] .…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for surgical treatment in preterm neonates with necrotizing enterocolitis: a multicenter case-control study

et al. 2020

View full text Add to dashboard Cite

Necrotizing enterocolitis (NEC) is one of the most common and lethal gastrointestinal diseases in preterm infants. Early recognition of infants in need for surgical intervention might enable early intervention. In this multicenter case-control study, performed in nine neonatal intensive care units, preterm born infants (< 30 weeks of gestation) diagnosed with NEC (stage ≥ IIA) between October 2014 and August 2017 were divided into two groups: (1) medical (conservative treatment) and (2) surgical NEC (sNEC). Perinatal, clinical, and laboratory parameters were collected daily up to clinical onset of NEC. Univariate and multivariate logistic regression analyses were applied to identify potential predictors for sNEC. In total, 73 preterm infants with NEC (41 surgical and 32 medical NEC) were included. A low gestational age (p value, adjusted odds ratio [95%CI]; 0.001, 0.91 [0.86–0.96]), no maternal corticosteroid administration (0.025, 0.19 [0.04–0.82]), early onset of NEC (0.003, 0.85 [0.77–0.95]), low serum bicarbonate (0.009, 0.85 [0.76–0.96]), and a hemodynamically significant patent ductus arteriosus for which ibuprofen was administered (0.003, 7.60 [2.03–28.47]) were identified as independent risk factors for sNEC.Conclusions: Our findings may support the clinician to identify infants with increased risk for sNEC, which may facilitate early decisive management and consequently could result in improved prognosis. What is Known:• In 27–52% of the infants with NEC, a surgical intervention is indicated during its disease course.• Absolute indication for surgical intervention is bowel perforation, whereas fixed bowel loop or clinical deterioration highly suggestive of bowel perforation or necrosi, is a relative indication. What is New:• Lower gestational age, early clinical onset, and no maternal corticosteroids administration are predictors for surgical NEC.• Low serum bicarbonate in the 3 days prior clinical onset and patent ductus arteriosus for which ibuprofen was administered predict surgical NEC.

show abstract

“… 1 , 2 Clinically, the presentation of infants with NEC often initially is quite subtle, yet over 24–48 hours progresses to abdominal distention, the passage of bloody stools, and systemic sepsis. 3 At laparotomy, which is required in nearly half of all cases of NEC, 4 patchy intestinal necrosis of the large and small intestine is detected, 5 which occasionally can require extensive resection. 6 In those infants who survive the initial onset of disease, long-term complications often develop, including severe inflammatory lung disease, 7 which is more severe than the lung disease that develops in premature infants in the absence of NEC, 8 , 9 neurologic dysfunction, 6 , 10 and the presence of short-bowel syndrome, 11 which is a devastating result of extensive intestinal resection.…”

mentioning

confidence: 99%

Toll-Like Receptor–Mediated Intestinal Inflammatory Imbalance in the Pathogenesis of Necrotizing Enterocolitis

Hackam

Sodhi

2018

Cellular and Molecular Gastroenterology and Hepatology

132

134

View full text Add to dashboard Cite

Necrotizing enterocolitis (NEC) remains the leading cause of death from gastrointestinal disease in premature infants and attacks the most fragile patients at a time when they appear to be the most stable. Despite significant advances in our overall care of the premature infant, NEC mortality remains stubbornly high. There is no specific treatment for NEC beyond broad-spectrum antibiotics and intestinal resection, and current efforts have focused on preventive strategies. Over the past decade, we have proposed a unifying hypothesis to explain the pathogenesis of NEC in premature infants that suggests that NEC develops in response to an imbalance between exaggerated proinflammatory signaling in the mucosa of the premature gut leading to mucosal injury, which is not countered effectively by endogenous repair processes, and in the setting of impaired mesenteric perfusion leads to intestinal ischemia and disease development. One of the most important pathways that mediates the balance between injury and repair in the premature intestine, and that plays a key role in NEC pathogenesis, is Toll-like receptor 4 (TLR4), which recognizes lipopolysaccharide on gram-negative bacteria. This review focuses on the role that the TLR4-mediated imbalance between proinflammatory and anti-inflammatory signaling in the premature intestinal epithelium leads to the development of NEC, and will explore how an understanding of the role of TLR4 in NEC pathogenesis has led to the identification of novel preventive or treatment approaches for this devastating disease.

show abstract

Predicting Mortality or Intestinal Failure in Infants with Surgical Necrotizing Enterocolitis

Cited by 17 publications

References 24 publications

Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis

Efficacy of abdominal ultrasound inspection in the diagnosis and prognosis of neonatal necrotizing enterocolitis

Predictive factors for surgical treatment in preterm neonates with necrotizing enterocolitis: a multicenter case-control study

Toll-Like Receptor–Mediated Intestinal Inflammatory Imbalance in the Pathogenesis of Necrotizing Enterocolitis

Contact Info

Product

Resources

About