Severe IUGR and Long Duration of Antibiotic Treatment may Overcome the Benefits of Appropriate Feeeding Strategies to Prevent Necrotising Enterocolitis
Abstract
Aim:To compare the characteristic features of premature neonates who developednecrotizing enterocolitis (NEC)or notand review the risks for NEC in our neonatal intensive care unit.
Materials and Method:Ninety four premature neonates with gestational age ≤ 35 weeks and/or birth weight ≤1500 g were included into the study. Characteristic features of the study neonates were compared.
Results:NECoccurred in 15.9% of the study population. Seventy nine neonates who did not develop NEC and 15 neonates who developed stage II and III NEC were compared. The rate of intrauterine growth restriction (IUGR), late onset sepsis and therefore broad-spectrum antibiotic usage were significantly higher in the group who developed NEC. At the time of diagnosis 93 % of NEC positive patients were on full feeds either with breast milk only or breast milk + fortifier, none of them were formula fed, 7 % of the cases were never fed. Surgery was performed in all stage III NEC patients and overall mortality rate was 33%.
Conclusion:Our findings suggest that together with exclusive breast feeding regimen, other strategies to prevent NEC should be implemented in this high risk preterm neonates.
References
Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011;364:255-64.
Henry MC, Moss RL. Necrotizing enterocolitis. Annu Rev Med 2009;60:111-24.
Alexander VN, Northrup V, Bizzarro MJ. Antibiotic exposure in the newborn intensive care unit and the risk of necrotizing enterocolitis. J Pediatr 2011;159:392-7.
Martinez-Tallo E, Claure N, Bancalari E. Necrotizing enterocolitis in full-term or near-term infants: risk factors. Biol Neonate. 1997;71:292-8.
Raboei EH. Necrotizing enterocolitis in full-term neonates: is it aganglionosis? Eur J Pediatr Surg 2009;19:101-4.
Holman RC, Stoll BJ, Curns AT, Yorita KL, Steiner CA, Schonberger LB. Necrotising enterocolitis hospitalisations among neonates in the United States. Paediatr Perinat Epidemiol 2006;20:498-506.
Boyd CA, Quigley MA, Brocklehurst P. Donor breast milk versus infant Formula for preterm infants: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2007;92:F169-75.
Kastenberg ZJ, Sylvester KG. The surgical management of necrotizing enterocolitis. Clinics in perinatology. 2013; 40:135–48.
Berseth CL, Bisquera JA, Paje VU. Prolonging small feeding volumes early in life decreases the incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics 2003;111:529-34.
Kennedy KA, Tyson JE, Chamnanvanakij S. Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed low-birth-weight infants. Cochrane Database Syst Rev; 2000 (2):CD001241.
Morgan J, Young L, McGuire W. Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants. Cochrane database of systematic reviews. 2013;28;3:CD001241.
Panigrahi P. Necrotizing enterocolitis: A practical guide to its prevention and management. Paediatr Drugs. 2006;8:151-65.
Couto RC, Pedrosa TM, Tofani CP, Pedroso ER. Risk factors for nosocomial infection in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2006;27:571-5.
Gewolb IH, Schwalbe RS, Taciak VL, Harrison TS, Panigrahi P. Stool microflora in extremely low birthweight infants. Arch Dis Child Fetal Neonatal Ed 1999;80:F167–F173.
Goldmann DA, Leclair J, Macone A. Bacterial colonization of neonates admitted to an intensive care environment. J Pediatr 1978; 93:288-93.
Cotten CM, Taylor S, Stoll B, Goldberg R, Hansen N, Sanchez P, et al. Prolonged duration of initial empirical antibiotic treatment is associatedwith increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics 2009;123:58-66.
Mazmanian SK, Liu CH, Tzianabos AO, Kasper DL. An immunomodulatory molecule of symbiotic bacteria directs maturation of the host immune system. Cell 2005;122:107–18.
Caicedo RA, Schanler RJ, Li N, Neu J. The developing intestinal ecosystem: implications for the neonate. Pediatr Res 2005;58:625–8.
Dogra S, Mukhopadhyay K, Narang A. Feed intolerance and necrotizing enterocolitis in preterm small-for-gestational age neonates with normal umbilical artery Doppler flow. J Trop Pediatr. 2012;58:513–6.
Dorling J, Kempley S, Leaf A. Feeding growth restricted preterm infants with abnormal antenatal Doppler results. Arch Dis Child Fetal Neonatal Ed. 2005;90:F359–63.
Been JV, Lievense S, Zimmermann LJ, Kramer BW, Wolfs TG. Chorioamnionitis as a risk factor for necrotizing enterocolitis: A systematic review andmeta-analysis. J Pediatr. 2013;162:236–42.
Christensen RD, Lambert DK, Henry E, Wiedmeier SE, Baer VL, Gerday E,et al. Is ‘‘transfusion associated necrotizing enterocolitis’’ an authentic pathogenic entity? Transfusion. 2010;50:1106-12.
Mohamed A, Shah PS. Transfusion associated necrotizing enterocolitis: A meta-analysis of observational data. Pediatrics. 2012;129:529–40.
