Impact of an In-House Pediatric Surgery Unit and Human Milk Centered Enteral Nutrition on Necrotizing Enterocolitis.

Sonja Zamrik,Michael Heldmann,Federica Giachero,Andreas C Jenke,Kai O Hensel,Stefan Wirth

doi:10.1155/2018/5042707

Abstract

The importance for mortality and morbidity of an in-house pediatric surgery unit for premature infants with necrotizing enterocolitis (NEC) remains undefined. Data on 389 consecutive very low birth weight infants with a birth weight <1250 g admitted between 2009 and 2014 was retrospectively analyzed in two almost identical neonatal intensive care units. Epidemiological data (n=172 and n=217, respectively) were comparable. Incidence of NEC stage II+ was significantly higher in center 1 (15.1 versus 5.5%, n=18 versus 6). This correlated with a significantly lower rate of exclusive human milk feeding compared to center 2 (24.2 versus 59.3%). Probiotic treatment did not differ. Importantly, in case of surgery the length of removed intestine (49.9 versus 19.5 cm) and the rate of severe short-bowel syndrome (38.9 versus 0 %) were significantly higher in center 1 (no in-house pediatric surgery). Furthermore, long-term morbidity assessment revealed more impaired motoric (-4.2 versus -2.2 months, p=0.21) and psychologic (-4.3 versus -1.6 months, p=0.09) development in center 1. Mortality was similar in both centers. Conclusions. Short- and possibly also long-term morbidity of NEC is clearly associated with the presence of an on-site pediatric surgery unit. Enteral nutrition with human milk seems to be a strong protective factor against NEC.

Highlights

Necrotizing enterocolitis (NEC) is still one of the most devastating acute disorders in premature infants [1,2,3,4]
We provide the first data on the effect of an on-site pediatric surgery department on the outcome of premature infants with NEC
No relevant significant differences were found between both cohorts including relevant outcome parameters such as intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), or severe bronchopulmonary dysplasia (BPD) (Table 1)

Summary

Introduction

Necrotizing enterocolitis (NEC) is still one of the most devastating acute disorders in premature infants [1,2,3,4]. Over the last decade evidence accumulated that an exaggerated, excessive, and unrestricted immature intestinal host immune response might be the primary factor leading to NEC. This is possibly triggered by environmental factors such as formula milk [5,6,7,8]. Mortality and morbidity, such as short-bowel syndrome or sepsis, are still high in these children in addition to the associated impairments in quality of life. Besides these individual problems, NEC is a major long-term social and financial burden for society [13]

Methods

Results

Conclusion