Variations in Incidence of Necrotizing Enterocolitis in Canadian Neonatal Intensive Care Units

Sankaran, Koravangattu; Puckett, Barbara; Lee, David S. C.; Seshia, Mary; Boulton, Jill; Qiu, Zhenguo; Lee, Shoo K.

doi:10.1097/00005176-200410000-00012

Cited by 152 publications

(102 citation statements)

References 19 publications

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“…1 The differences persist even when outcomes of only outborn infants are compared among neonates admitted to children's hospital NICUs versus perinatal NICUs. 2,3 In the United States and Canada, children's hospital NICUs have an important role in extending specialized pediatric diagnostic and therapeutic services to newborns.…”

Section: Introductionmentioning

confidence: 99%

Predictors of mortality and length of stay for neonates admitted to children's hospital neonatal intensive care units

et al. 2007

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Objective: Current scoring systems, which adjust prediction for severity of illness, do not account for higher observed mortality in neonatal intensive care units (NICUs) of children's hospitals than that of perinatal centers. We hypothesized that three potential predictors, (a) admission from another NICU, (b) presence of congenital anomalies and (c) need for surgery, would modify expected mortality and/or length of stay for infants admitted to NICUs in children's hospitals.Study Design: We reviewed consecutive admissions to two NICUs in children's hospitals in Canada. We performed regression analyses to evaluate these potential predictors and severity-of-illness indices for the outcomes of mortality and length of stay.Result: Of 625 neonatal admissions, transfer from another NICU, congenital anomalies requiring admission and surgery were identified in 371 (59%). Using logistic regression, mortality was predicted based on admission from another NICU (odds ratio (OR) 1.92; 95% confidence interval (CI) 1.04, 3.57), congenital anomalies (OR 7.28; 95% CI 3.69, 14.36) and a validated severity-of-illness score, the Score for Neonatal Acute Physiology Perinatal Extension Version II (SNAPPE-II; OR 1.07; 95% CI 1.05, 1.09 per point). By contrast, surgical intervention was predictive of survival (OR 0.35; 95% CI 0.18, 0.67). Length of stay X21 days was predicted by SNAPPE-II (OR 1.02; 95% CI 1.01, 1.03 per point), congenital anomalies (OR 2.47; 95% CI 1.60, 3.79) and surgery (OR 2.73; 95% CI 1.77, 4.21).Conclusion: Fair performance comparisons of NICUs with different casemixes, such as children's hospital and perinatal NICUs, in addition to severity-of-illness indices, should account for admissions from another NICU, congenital anomalies and surgery.

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Section: Introductionmentioning

confidence: 99%

Predictors of mortality and length of stay for neonates admitted to children's hospital neonatal intensive care units

et al. 2007

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“…One additional factor commonly associated with NEC in premature infants is the presence of a hemodynamically significant patent ductus arteriosus. Although causation has not been established, infants with PDA have an increased incidence of NEC [20][21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency of the newborn infant and a leading cause of mortality in the neonatal period [1,2]. Given the increase in low birth weight deliveries and recent advances in neonatal intensive care, a growing percentage of newborn infants are at risk of developing NEC.…”

Section: Introductionmentioning

confidence: 99%

Association of Escherichia coli O157:H7 with necrotizing enterocolitis in a full-term infant

et al. 2009

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Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency of the neonate. NEC is predominantly seen in premature infants; however, in rare instances it can affect full-term infants as well. Although the pathogenesis of NEC remains elusive, it is well established that bacterial colonization is required for development of this disease. In this report, we present a case of a full-term infant, who developed a very aggressive form of NEC and was found to have Escherichia coli (E. coli) O157:H7 both in stool and blood cultures. Unfortunately, despite aggressive surgical and intensive care management, this infant suffered pan-intestinal necrosis and expired. We were not able to establish the route of transmission. To our knowledge, this is the first report of the association of E. coli O157:H7 with NEC.

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“…Thus, it is not surprising that some the of the best data to date elucidating the risk factors for NEC have been produced by large neonatal networks. [1][2][3][4][5][6] These must be supported and will be vital as we move forward.…”

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confidence: 99%

Necrotizing Enterocolitis: Finding Infants at Highest Risk

Abdullah

2008

J Perinatol

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Despite decades of research, necrotizing enterocolitis (NEC) remains one of the conditions within our neonatal intensive care units with the highest mortality. Experience has garnered the common realization that preterm infants and those requiring surgical therapy will fare the worst. However, clear clinical predictors to identify positively which infants will progress with the disease remain elusive.In this edition of The Journal of Perinatology, Moss and other investigators from six children's hospital across the United States present their data from their prospective, observational study. Although a negative study in which no new model could be developed to predict NEC, the analysis is an important contribution to further expand our knowledge of the risk factors for NEC progression. Dr Moss and colleagues characterized 455 infants with NEC into 'nonprogressors' who reached full feeding without surgical therapy or 'progressors' who either required surgical therapy or died from disease. Dedicated research nurses from the network collected data from a wide array of maternal, antenatal, intrapartum and newborn histories. Extensive daily feeding data including the mode and specific type of formula and/or total parenteral nutrition combination were also collected. Infants were followed during their inpatient hospitalization and extensive clinical data were collected relating to medications, radiology findings, ventilatory requirements, fluid and blood culture status. If infants received surgical therapy, surgical findings and postoperative data were also included in the analysis. The authors identified independent risk factors for progression of disease, with a particular focus on clinical information available at the time of diagnosis. Univariate analysis revealed NEC and progression to be associated with factors such as early gestational age, decreased birthweight, maternal age, intubation, compressions and portal venous gas, among others. Multivariate analysis identified 12 risk factors with 3 not previously described: teenaged mother, never have received enteral feeds before diagnosis and receipt of cardiac compressions/resuscitative drugs at delivery. Previously described risk factors were confirmed including factors such as Gramnegative bacteremia, portal venous gas, pneumatosis, metabolic acidosis at diagnosis, bandemia and low birth weight.One of the most interesting findings of this paper is the progression of NEC in infants who had never received enteral feeds. One plausible explanation for this finding might be that infants with NEC were being diagnosed early in life and thus may have

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Variations in Incidence of Necrotizing Enterocolitis in Canadian Neonatal Intensive Care Units

Abstract: Risk factors for NEC were different in VLBW and HBW infants. There was no significant variation in the risk-adjusted incidence of NEC among Canadian NICUs, with one possible exception.

Cited by 152 publications

References 19 publications

Predictors of mortality and length of stay for neonates admitted to children's hospital neonatal intensive care units

Predictors of mortality and length of stay for neonates admitted to children's hospital neonatal intensive care units

Association of Escherichia coli O157:H7 with necrotizing enterocolitis in a full-term infant

Necrotizing Enterocolitis: Finding Infants at Highest Risk

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