Prevention of Neonatal Necrotizing Enterocolitis

Carrion, Vivien; Egan, Edmund A.

doi:10.1097/00005176-199010000-00006

Cited by 84 publications

(47 citation statements)

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“…In the infants who were 26 to 29 weeks' gestation, gastric pH levels were Ͻ3 throughout the testing period from days 1 to 17. These findings were in contrast with those of Carrion and Egan, 6 who reported that in infants of Ͻ1250 g birth weight, the median gastric pH level was 4.0 for the first 4 weeks after birth. They were able to decrease the median pH level to 3.0 with the addition of 1 N HCl to the study infants' feeds.…”

Section: Discussioncontrasting

confidence: 98%

“…In a large cohort of Ͼ11 000 VLBW infants, treatment with H2 blockers was associated with a higher incidence of NEC, which is consistent with the results of a small randomized trial of acidification of feeds 6 that showed that a lower gastric pH level was associated with a decreased incidence of NEC.…”

Section: Discussionsupporting

confidence: 83%

“…In light of the findings of Carrion and Egan, 6 we postulated that maintenance of a relatively less acidic gastric milieu would be associated with an increased incidence of NEC, possibly through bacterial overgrowth. There was no clear evidence of benefit of the use of H2 blockers; in fact, H2-blocker therapy seemed to be a significant risk factor for the development of NEC.…”

Section: Discussionmentioning

confidence: 90%

“…Their data demonstrated that acidification decreased gastric bacterial colonization and significantly reduced the incidence of NEC (P ϭ .02). 6 Histamine-2 receptor (H2) blockers are used in neonates to increase the gastric pH level in a variety of clinical situations, often without data proving benefit. They are administered to neonates with proven or presumed gastroesophageal reflux to minimize esophagitis and also may be given to neonates who are receiving steroids to minimize the associated gastritis.…”

mentioning

confidence: 99%

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Association of H2-Blocker Therapy and Higher Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants

et al. 2006

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OBJECTIVE. We sought to determine if an association exists between the use of histamine-2 receptor (H2) blockers and the incidence of necrotizing enterocolitis (NEC) in infants of 401 to 1500 g in birth weight. STUDY DESIGN. Data from the National Institute of Child Health and Human Development Neonatal Research Network very low birth weight (401–1500 g) registry from September 1998 to December 2001 were analyzed. The relation between the diagnosis of NEC (Bell stage II or greater) and antecedent H2-blocker treatment was determined by using case-control methodology. Conditional logistic regression was implemented, controlling for gender, site of birth (outborn versus inborn), Apgar score of <7 at 5 minutes, and postnatal steroids. RESULTS. Of 11072 infants who survived for at least 12 hours, 787 (7.1%) developed NEC (11.5% of infants 401–750 g, 9.1% of infants 751–1000 g, 6.0% of infants 1001–1250 g, and 3.9% of infants 1251–1500 g). Antecedent H2-blocker use was associated with an increased incidence of NEC (P < .0001). CONCLUSIONS. H2-blocker therapy was associated with higher rates of NEC, which is in agreement with a previous randomized trial of acidification of infant feeds that resulted in a decreased incidence of NEC. In combination, these data support the hypothesis that gastric pH level may be a factor in the pathogenesis of NEC.

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Section: Discussioncontrasting

confidence: 98%

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 90%

mentioning

confidence: 99%

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Association of H2-Blocker Therapy and Higher Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants

et al. 2006

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“…Carrion and Egan [186] have documented that acidifying the feedings of preterm neonates to a pH low enough to inhibit gastric bacterial proliferation significantly lowers the risk and incidence of NEC.…”

Section: Acidification Of Gastric Contentsmentioning

confidence: 99%

Necrotizing enterocolitis: A multifactorial disease with no cure

Schnabl

Aerde²,

Thomson³

et al. 2008

WJG

161

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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Gastric Residual to Predict Necrotizing Enterocolitis in Preterm Piglets As Models for Infants

Kappel

Sangild

Hilsted

et al. 2020

J Parenter Enteral Nutr

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Background Necrotizing enterocolitis (NEC) is a serious intestinal inflammatory disease in preterm infants. High volume of gastric residual (GR) after oral feedings is often used as a predictor of NEC, but evidence is limited. Using NEC‐sensitive preterm piglets as models, we hypothesized that GR mass and related plasma biomarkers predict early onset of NEC. Methods In total, 258 newborn preterm piglets were fed bovine milk–based formulas for 5 days. At euthanasia, the stomach, small intestine, and colon were evaluated for NEC lesions. Mass, acidity, gastrin, and bile acid levels were determined for GR content, together with gastrin, glucagon‐like peptide 2 (GLP‐2), and gastric inhibitory polypeptide (GIP) levels in plasma. Results In total, 48% of piglets had NEC lesions in the small intestine and/or colon. These piglets had higher GR mass (+32%, P < 0.001) and lower gastric bile acid concentrations (−22%, P < 0.05) than piglets without NEC lesions. The positive and negative predictive values for these markers were 34%–61%. Gastric acidity, gastrin, GLP‐2, and GIP levels were similar for piglets with and without NEC lesions. Conclusion Elevated GR mass correlates positively with NEC lesions but may be a poor predictor of NEC, even when combined with other biomarkers. More knowledge about gastric emptying and gut transit in preterm neonates is required to understand how GR volume and composition relate to morbidities, such as NEC, in preterm neonates.

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Prevention of Neonatal Necrotizing Enterocolitis

Cited by 84 publications

References 0 publications

Association of H2-Blocker Therapy and Higher Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants

Association of H2-Blocker Therapy and Higher Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants

Necrotizing enterocolitis: A multifactorial disease with no cure

Gastric Residual to Predict Necrotizing Enterocolitis in Preterm Piglets As Models for Infants

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