Risk factors for necrotizing enterocolitis in neonates: a systematic review of prognostic studies

Samuels, Noor; Graaf, Rob A. van de; Jonge, Rogier C. J. de; Reiss, Irwin; Vermeulen, Marijn J.

doi:10.1186/s12887-017-0847-3

Cited by 204 publications

(173 citation statements)

References 51 publications

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“…Other morbidities in the neonatal intensive care unit (NICU) such as necrotizing enterocolitis (NEC) also have high mortality rates and have been associated with prolonged antibiotic exposure. 10,11 . Nevertheless, antibiotics remain the most commonly prescribed medication in the NICU 12,13 .…”

Section: Mainmentioning

confidence: 99%

Antibiotics and the developing intestinal microbiome, metabolome and inflammatory environment: a randomized trial of preterm infants

Russell

Ruoss

Cruz

et al. 2020

Preprint

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15Antibiotic use in neonates can have detrimental effects on the developing gut microbiome, 16increasing the risk of morbidity. A majority of preterm neonates receive antibiotics after birth 17 without clear evidence to guide this practice. Increasing evidence suggests associations between 18 early-life antibiotic use, intestinal dysbiosis, and morbidity that challenge the efficacy of this 19 common neonatal practice. Here we present microbiome and metabolomic results from the 20 Routine Early Antibiotic use in Symptomatic preterm Neonates (REASON) study, which is the 21 first trial to randomize symptomatic preterm neonates to receive or not receive antibiotics in the 22 first 48 hours after birth. Using 16S rRNA sequencing of stool samples collected longitudinally 23for 91 neonates, we show that antibiotics alter trends in microbiome diversity and development 24 between randomized neonates and illustrate that type of nutrition helps shape the early infant gut 25 microbiome. Integrating multi-omic data for the gut microbiome, stool immune markers, stool 26 metabolites, and inferred metabolic pathways, we identified an association between Veillonella 27 and the neurotransmitter gamma-aminobutyric acid (GABA). Our results suggest early antibiotic 28 use may impact the gut-brain axis with the potential for consequences in early life development. 29 Main 30Premature infants are particularly susceptible to infections secondary to increased need for 31 invasive procedures and immaturity of the immune system, skin, and gastrointestinal tract1-3. 32Increasingly, there is growing concern that risk factors for mortality may originate from 33underlying pathologies that could also be responsible for premature birth4. Symptoms of 34 prematurity are difficult to discern from symptoms of infection which, compounded by the 35 3 increased risk of infection, have led to most premature infants being exposed to antibiotics early 36 in life5-7. Despite high mortality rates, the incidence of culture positive early onset sepsis (EOS) 37 is relatively low, between 0.2-0.6%8. In the absence of a positive culture, a majority of preterm 38 infants receive antibiotics immediately after birth based on maternal risk factors (e.g. intra-39 amniotic infection) or laboratory abnormalities (e.g. elevated serum C-reactive protein (CRP) 40 because of the risk of mortality8. Given the low incidence of culture positive EOS in this 41 population, it is possible that such high rates of antibiotic use are unnecessary and may increase 42 morbidity in these infants9. Other morbidities in the neonatal intensive care unit (NICU) such as 43 necrotizing enterocolitis (NEC) also have high mortality rates and have been associated with 44 prolonged antibiotic exposure.10,11. Nevertheless, antibiotics remain the most commonly 45 prescribed medication in the NICU12,13. 46The gut microbiome comprises a highly volatile community structure early in life14. Microbial 47Randomized clinical trials have the advantage of controlling for the numerous covariates that 58 cou...

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Section: Mainmentioning

confidence: 99%

Antibiotics and the developing intestinal microbiome, metabolome and inflammatory environment: a randomized trial of preterm infants

Russell

Ruoss

Cruz

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Several studies, mostly retrospective in design, have aimed to identify independent risk factors for NEC. Prematurity and low birth weight were the most consistently identified risk factors for the development of NEC [3]. Other reported risk factors include the administration of bovine-origin formula [4], low Apgar scores [5], small for GA [6], treatment of patent ductus arteriosus (PDA) [7], erythrocyte transfusions [8], and nosocomial infections [9].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

et al. 2018

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Background: The identification of independent clinical risk factors for necrotizing enterocolitis (NEC) may contribute to early selection of infants at risk, allowing for the development of targeted strategies aimed at the prevention of NEC. Objective: The objective of this study was to identify independent risk factors contributing to the development of NEC in a large multicenter cohort. Methods: This prospective cohort study was performed in 9 neonatal intensive care units. Infants born at a gestational age ≤30 weeks were included. Demographic and clinical data were collected daily until day 28 postnatally. Factors predictive of the development of NEC were identified using univariate and multivariable analyses in a 1: 5 matched case-control cohort. Results: In total, 843 infants (56 NEC cases) were included in this study. In the case-control cohort, univariate analysis identified sepsis prior to the onset of NEC and formula feeding to be associated with an increased risk of developing NEC, whereas the administration of antibiotics directly postpartum was inversely associated with NEC. In a multivariable logistic regression model, enteral feeding type and the number of days parenterally fed remained statistically significantly associated with NEC, whereas the administration of antibiotics directly after birth was associated with a lower risk of developing NEC. Conclusions: Formula feeding and prolonged (duration of) parenteral feeding were associated with an increased risk of NEC. Contrary to expectations, the initiation of treatment with antibiotics within 24 h after birth was inversely associated with NEC.

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“…Studies have reported that NEC is associated with a range of interventions including non-steroidal anti-inflammatory drug use,3 blood transfusion,4 H2-blockers5 and prolonged antibiotic exposure6 but the data are inconsistent and prognostic studies are rare 7. Most often there are no clear single antecedent events.…”

Section: Necrotising Enterocolitis Heterogeneitymentioning

confidence: 99%

How to feed a baby recovering from necrotising enterocolitis when maternal milk is not available

Embleton

Zalewski

2017

Arch Dis Child Fetal Neonatal Ed

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Necrotising enterocolitis (NEC) is a devastating disease with significant mortality and serious adverse outcomes in at least 50% including short gut and poor neurodevelopment. Research and management are complicated by a lack of robust clinical markers, and without histological confirmation, there is a risk of both underdiagnosis and overdiagnosis. Interunit variations in the thresholds for surgical referral, laparotomy and postmortem rates mean the actual incidence is difficult to determine, especially because the histological term 'NEC' is used in practice to describe a heterogeneous clinical syndrome. In this article, we discuss issues relating to choice of milk feed type following a clinical diagnosis of 'NEC' where mother's own milk is not available. We review common clinical concerns relating to feeding following NEC and the rationale for modifications of the macronutrient composition and quality of formula milk.

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Risk factors for necrotizing enterocolitis in neonates: a systematic review of prognostic studies

Cited by 204 publications

References 51 publications

Antibiotics and the developing intestinal microbiome, metabolome and inflammatory environment: a randomized trial of preterm infants

Antibiotics and the developing intestinal microbiome, metabolome and inflammatory environment: a randomized trial of preterm infants

Risk Factors for Necrotizing Enterocolitis: A Prospective Multicenter Case-Control Study

How to feed a baby recovering from necrotising enterocolitis when maternal milk is not available

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