Risk Factors for Necrotizing Enterocolitis in Infants With Patent Arterial Duct. A Retrospective Matched Paired Analysis

Haefeli, Stephanie; Kordasz, Marcin; Tsai, Catherine; Hau, Eva-Maria; Klimek, Peter; Cholewa, D.; Pavlović, Mladen; Berger, Steffen; Kessler, Ulf

doi:10.3389/fped.2020.00179

“…There was no association between infants who developed one episode of isolated hypotension during the first 72 hours of life and NEC, irrespective of whether they were treated for hypotension or not, in a subgroup of EPIPAGE 2 cohort study 28 . In a retrospective case control study, Haefeli et al reported that hypotension did not increase the risk of NEC in infants with PDA 29 . Similar to the present study, Faust and colleagues reported that severe NEC was lower among babies with high BP compared to babies with low BP during the first 24 hours of life 3 .…”

Section: Discussionmentioning

confidence: 97%

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants

Aladangady

¹

,

Sinha

²

,

Banerjee

³

et al. 2023

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Background: There remains uncertainty about the definition of normal blood pressure (BP), and when to initiate treatment for hypotension for extremely preterm infants. To determine the short-term outcomes of extremely preterm infants managed by active compared with permissive BP support regimens during the first 72 hours of life. Method: This is a retrospective medical records review of 23+0–28+6 weeks’ gestational age (GA) infants admitted to neonatal units (NNU) with active BP support (aimed to maintain mean arterial BP (MABP) >30 mmHg irrespective of the GA) and permissive BP support (used medication only when babies developed signs of hypotension) regimens. Babies admitted after 12 hours of age, or whose BP data were not available were excluded. Results: There were 764 infants admitted to the participating hospitals; 671 (88%) were included in the analysis (263 active BP support and 408 permissive BP support). The mean gestational age, birth weight, admission temperature, clinical risk index for babies (CRIB) score and first haemoglobin of infants were comparable between the groups. Active BP support group infants had consistently higher MABP and systolic BP throughout the first 72 hours of life (p<0.01). In the active group compared to the permissive group 56 (21.3%) vs 104 (25.5%) babies died, and 21 (8%) vs 51 (12.5%) developed >grade 2 intra ventricular haemorrhage (IVH). Death before discharge (adjusted OR 1.38 (0.88 – 2.16)) or IVH (1.38 (0.96 – 1.98)) was similar between the two groups. Necrotising enterocolitis (NEC) ≥stage 2 was significantly higher in permissive BP support group infants (1.65 (1.07 – 2.50)). Conclusions: There was no difference in mortality or IVH between the two BP management approaches. Active BP support may reduce NEC. This should be investigated prospectively in large multicentre randomised studies.

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“…The pathophysiology of NEC is multifactorial and has not as of yet been fully clarified. Prematurity, formula feeding, and intestinal dysbiosis are the main risk factors, while the genetic predisposition as well as certain prenatal and postnatal factors increase the risk of NEC ( Table 1) (12)(13)(14)(15)(16)(17)(18)(19)(20)(21).…”

Section: Pathophysiology and Current Diagnosis Of Necrotizing Enterocmentioning

confidence: 99%

Emerging Biomarkers for Prediction and Early Diagnosis of Necrotizing Enterocolitis in the Era of Metabolomics and Proteomics

Agakidou

¹

,

Agakidis

²

,

Gika

³

et al. 2020

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Necrotizing Enterocolitis (NEC) is a catastrophic disease affecting predominantly premature infants and is characterized by high mortality and serious long-term consequences. Traditionally, diagnosis of NEC is based on clinical and radiological findings, which, however, are non-specific for NEC, thus confusing differential diagnosis of other conditions such as neonatal sepsis and spontaneous intestinal perforation. In addition, by the time clinical and radiological findings become apparent, NEC has already progressed to an advanced stage. During the last three decades, a lot of research has focused on the discovery of biomarkers, which could accurately predict and make an early diagnosis of NEC. Biomarkers used thus far in clinical practice include acute phase proteins, inflammation mediators, and molecules involved in the immune response. However, none has been proven accurate enough to predict and make an early diagnosis of NEC or discriminate clinical from surgical NEC or other non-NEC gastrointestinal diseases. Complexity of mechanisms involved in NEC pathogenesis, which remains largely poorly elucidated, could partly explain the unsatisfactory diagnostic performance of the existing NEC biomarkers. More recently applied technics can provide important insight into the pathophysiological mechanisms underlying NEC but can also aid the detection of potentially predictive, early diagnostic, and prognostic biomarkers. Progress in omics technology has allowed for the simultaneous measurement of a large number of proteins, metabolic products, lipids, and genes, using serum/plasma, urine, feces, tissues, and other biological specimens. This review is an update of current data on emerging NEC biomarkers detected using proteomics and metabolomics, further discussing limitations and future perspectives in prediction and early diagnosis of NEC.

show abstract

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants

Aladangady

¹

,

Sinha

²

,

Banerjee

³

et al. 2023

View full text Add to dashboard Cite

Background: There remains uncertainty about the definition of normal blood pressure (BP), and when to initiate treatment for hypotension for extremely preterm infants. To determine the short-term outcomes of extremely preterm infants managed by active compared with permissive BP support regimens during the first 72 hours of life. Method: This is a retrospective medical records review of 23+0–28+6 weeks’ gestational age (GA) infants admitted to neonatal units (NNU) with active BP support (aimed to maintain mean arterial BP (MABP) >30 mmHg irrespective of the GA) and permissive BP support (used medication only when babies developed signs of hypotension) regimens. Babies admitted after 12 hours of age, or whose BP data were not available were excluded. Results: There were 764 infants admitted to the participating hospitals; 671 (88%) were included in the analysis (263 active BP support and 408 permissive BP support). The mean gestational age, birth weight, admission temperature, clinical risk index for babies (CRIB) score and first haemoglobin of infants were comparable between the groups. Active BP support group infants had consistently higher MABP and systolic BP throughout the first 72 hours of life (p<0.01). In the active group compared to the permissive group 56 (21.3%) vs 104 (25.5%) babies died, and 21 (8%) vs 51 (12.5%) developed >grade 2 intra ventricular haemorrhage (IVH). Death before discharge (adjusted OR 1.38 (0.88 – 2.16)) or IVH (1.38 (0.96 – 1.98)) was similar between the two groups. Necrotising enterocolitis (NEC) ≥stage 2 was significantly higher in permissive BP support group infants (1.65 (1.07 – 2.50)). Conclusions: There was no difference in mortality or IVH between the two BP management approaches. Active BP support may reduce NEC. This should be investigated prospectively in large multicentre randomised studies.

show abstract

Risk Factors for Necrotizing Enterocolitis in Infants With Patent Arterial Duct. A Retrospective Matched Paired Analysis

Cited by 3 publications

References 18 publications

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants

Emerging Biomarkers for Prediction and Early Diagnosis of Necrotizing Enterocolitis in the Era of Metabolomics and Proteomics

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants

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