Neonatal Enterocolitis Research Articles

Melatonin administration as an adjuvant therapy in neonatal necrotizing enterocolitis

Objective: Determine the value of melatonin as an adjuvant therapy in treating necrotizing enterocolitis (NEC) in neonates. Patients and Methods: A prospective clinical trial study was conducted on 50 neonates which suffer from picture like NEC to detect cases with evident NEC diagnosed on the basis of both clinical and laboratory criteria. Enrolled neonates were divided into two groups: Studied group (G I) (n = 25) received melatonin and antibiotics, while the control group (G II) (n = 25) was treated with antibiotics only. Melatonin was administered as 20 mg for 3 consecutive days and antibiotics were administered according to a standard protocol. Results: Showed comparison between Group I and Group II according to incidence of NEC at the onset of the research and after 1 week of onset wherein Group I there were 6 neonates out of 25 neonates at the onset of research suffering from NEC and became 1 neonate only after 1 week showing significant difference in Group I (P 0.05. Conclusion: Melatonin administration as an adjuvant therapy in neonatal NEC treatment is associated with improvement of clinical and laboratory outcome.

Preoperative Feeding Neonates With Cardiac Disease.

The potential for necrotizing enterocolitis (NEC) in neonates requiring cardiac surgery has contributed largely to wide feeding practice variations and a hesitation to initiate enteral feeding during the preoperative period, specifically those patients with hypoplastic left heart syndrome. A retrospective chart review of neonates undergoing cardiac surgery at a single institution between July 2011 and July 2013 was performed. The primary objective of this study was to determine if preoperative feeding was associated with NEC in neonates requiring cardiac surgery. Univariable and multivariable analyses were performed to evaluate the relationship between preoperative feeding and NEC. Secondary outcomes including growth failure, total ventilator days, total length of stay, and tube-assisted feeds at discharge were analyzed. One hundred thirty consecutive neonates who required cardiac surgery were included in the analysis. Preoperative feeding occurred in 61% (n = 79). The overall prevalence of NEC was 9% (12/130), including three neonates with surgical NEC. There was no difference in the prevalence of NEC between the preoperative feeding and nil per os (NPO) groups. Preoperative NPO status was associated with longer ventilator-dependent days ( P = .01) but was not associated with worsened growth failure, longer length of stay, or increased prevalence of tube-assisted feeds at discharge. In this study cohort, preoperative feeding was associated with a low prevalence of NEC. Larger prospective studies evaluating the safety and benefits of preoperative feeding in cardiac neonates are warranted.

Beneficial effects of mucous fistula refeeding in necrotizing enterocolitis neonates with enterostomies

BackgroundNecrotizing enterocolitis in premature neonates often results in bowel resection and stoma formation. One way to promote bowel adaptation before stoma closure is to introduce proximal loop effluents into the mucous fistula. In this study, we reviewed our experience with distal loop refeeding with respect to control group. MethodsAll patients with necrotizing enterocolitis between 2000 and 2014 necessitating initial diverting enterostomies and subsequent stoma closure in a tertiary referral center were included. Medical records were retrospectively reviewed. Demographic data, surgical procedures, and postoperative outcomes were analyzed. Results92 patients were identified, with 77 patients receiving mucous fistula refeeding. The refeeding group showed less bowel ends size discrepancy (25 vs 53%, p=0.034) and less postoperative anastomotic leakage (3 vs 20%, p=0.029). Fewer refeeding group patients developed parenteral nutrition related cholestasis (42 vs 73%, p=0.045) and required shorter parenteral nutrition support (47 vs 135days, p=0.002). The mean peak bilirubin level was higher in the non-refeeding group (155 vs 275μmol/L, p<0.001). No major complication was associated with refeeding. ConclusionsMucous fistula refeeding is safe and can decrease risk of anastomotic complication and parental nutrition related cholestasis. It provides both diagnostic and therapeutic value preoperatively and its use should be advocated.Level III Treatment Study in a Case Control Manner.

Fecal calprotectin levels in preterm infants with and without feeding intolerance

ObjectivesTo assess the level of fecal calprotectin in preterm neonates with feeding intolerance, as well as to evaluate it as a marker of feeding intolerance and to determine a cut‐off level of fecal calprotectin in feeding intolerance. MethodsAnalytical, multicenter, case–control study, which was carried out in neonatal intensive care units in Egypt, in a period from August 1, 2014 to March 1, 2015 on 52 preterm neonates. Neonates were classified into two groups; a study group including 26 neonates who met inclusion criteria and a control group including 26 neonates for comparison. ResultsFecal calprotectin levels ranged from 3.9μg/g to 971.8μg/g, and there was a significant increase in fecal calprotectin in the study group when compared to the control group (334.3±236.6μg/g vs. 42.0±38.2μg/g, respectively) with moderate inverse significant correlation between fecal calprotectin and birth weight. Furthermore, there was moderate, significant correlation between fecal calprotectin and duration of breastfeeding range. On the other hand, there was no correlation between fecal calprotectin and post‐natal age, gestational age, or volume of feeding. A cut‐off at the 67.0μg/g level, with 100.0% sensitivity and 76.9% specificity, was considered. ConclusionFecal calprotectin level increased significantly in neonates with feeding intolerance; it can be used to detect early cases with necrotizing enterocolitis in neonates, but this subject still needs more investigations on more patients.

Efficacy of Probiotics Versus Placebo in the Prevention of Necrotizing Enterocolitis in Preterm Very Low Birth Weight Infants: A Double-Blind Randomized Controlled Trial.

To evaluate the efficacy of orally administered probiotics in preventing necrotizing enterocolitis (NEC) in preterm very low birth weight (VLBW) infants. Arandomized double blind controlled trial. The Paediatrics Department of Sylhet M.A.G. Osmani Medical College Hospital, Sylhet Bangladesh, from July 2012 to June 2015. Preterm (28 - 33 weeks gestation) VLBW (birth weight 1000 - 1499 g) neonates were enrolled. The study group was fed with probiotics once daily with breast milk from first feeding, and the control group with only breast milk without the addition of probiotics. Both the groups received other standard care. The primary outcome was the development of NEC (stage II and III), categorized by modified Bell's classification. In 108 neonates, development of NEC was significantly lower in the study group than that of control group [1 (1.9%) vs. 6 (11.5%); p=0.044]. Age of achievement of full oral feeding was significantly earlier in the study group than that in the control group (14.88 ±3.15 and 18.80 ±4.32 days; p < 0.001). Duration of hospital stay was significantly short in the study group compared to the control group (15.82 ±2.94 days vs. 19.57 ±4.26 days; p < 0.001). Probiotic supplementation reduces the frequency of necrotising enterocolitis in preterm neonates with very low birth weight. It is also associated with faster achievement of full oral feeding and short duration of hospital stay.

Efficacy of Lactobacillus Acidophilus DDS-1, Lactobacillus Bulgaricus, Bifidobacterium Infantis in the Prevention of Necrotizing Enterocolitis in Preterm Neonates

Objectives: To compare the efficacy of combination of lactobacillus acidophilus DDS-1, lactobacillus bulgaricus, bifidobacterium infantis in the prevention of necrotizing enterocolitis in preterm neonates with placebo. Study Design: Randomized controlled trial. Duration of Study: May 2012 to October 2012. Setting: Department of Pediatric Medicine, Allied Hospital, Faisalabad. Methodology: Over 6 months, 220 preterm neonates meeting the inclusion criteria were selected and were assigned randomly to two groups after parental informed consent was obtained. The neonates in study group received probiotic with breast milk or preterm formula milk and neonates in control group received breast milk or preterm formula milk. Both groups were observed for the development of clinical evidence of NEC. The Data was statistically analyzed; Chi square test and Fischer’s exact test was applied to compare both groups for presence of NEC. Results: The number of days required to reach full enteral feeding (study group 8.73±3.87 days vs control group 10.72±5.43 days; p-value 0.002) and duration of hospital stay was (study group 11.35±6.74 vs control group 15.35±10.29; p-value 0.001) significantly low in the probiotic-exposed group compared with the control. The incidence of NEC (study group 10.0% vs control group 22.72%; p-value 0.011) was significantly low in the probiotic-exposed group when compared with non-exposed group. Conclusion: Alteration of microbial florae following oral supplementation of probiotics along with human milk have beneficial effects in reducing the incidence of NEC especially in pre-term neonates.

The role of probiotics in preventing necrotising enterocolitis in neonates

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Probiotics for the Prevention of Necrotizing Enterocolitis in Preterm Neonates

Necrotizing enterocolitis is a life-threatening condition in preterm neonates that is associated with severe morbidity and mortality. Several studies have suggested that probiotics can potentially decrease the risk of developing necrotizing enterocolitis via several proposed mechanisms of action, including increasing diversity of the intestinal flora. However, due to a lack of standardized study designs, including variability in product selection, dose, time of initiation, and duration, as well as a concern for safety in this vulnerable population, the use of probiotics in this population remains controversial. Regulations for testing of products and well-validated dosing regimens are needed before considering routine use of probiotics in these high-risk patients.

Risk Factors for Necrotizing Enterocolitis in Neonates: A Retrospective Case-Control Study

Necrotizing enterocolitis (NEC) in neonates is devastating, and risk-factor identification is crucial. This study aimed to evaluate risk factors for NEC in different gestational age (GA) groups. Risk factors associated with NEC were investigated using a retrospective case-control design. Patients with Bell's Stage NEC≥II were divided into three groups based on GA: I, <34 weeks; II, ≥34 weeks but <37 weeks; III, ≥37 weeks. Each case was paired with two GA- and weight-matched controls. Data were collected from medical records, and univariate and conditional logistic regression analyses employed. A total of 238 cases and 476 controls were enrolled. Variation in the months when NEC was diagnosed was noted, with a peak in January and a trough in August. Intrahepatic cholestasis of pregnancy and transfusion with packed red blood cells were significantly associated with NEC in preterm infants. Meconium aspiration syndrome was an independent risk factor for a greater chance of NEC development in full-term infants. Postnatal asphyxia and sepsis were associated with an increased risk of NEC in all groups. Probiotic use was associated with a reduced risk of NEC. Patients aged >34 weeks with congenital heart disease were more likely than controls to have NEC. Intrahepatic cholestasis of pregnancy and meconium aspiration syndrome may be new risk factors for NEC.

Fecal calprotectin levels in preterm infants with and without feeding intolerance

ObjectivesTo assess the level of fecal calprotectin in preterm neonates with feeding intolerance, as well as to evaluate it as a marker of feeding intolerance and to determine a cut-off level of fecal calprotectin in feeding intolerance. MethodsAnalytical, multicenter, case–control study, which was carried out in neonatal intensive care units in Egypt, in a period from August 1, 2014 to March 1, 2015 on 52 preterm neonates. Neonates were classified into two groups; a study group including 26 neonates who met inclusion criteria and a control group including 26 neonates for comparison. ResultsFecal calprotectin levels ranged from 3.9μg/g to 971.8μg/g, and there was a significant increase in fecal calprotectin in the study group when compared to the control group (334.3±236.6μg/g vs. 42.0±38.2μg/g, respectively) with moderate inverse significant correlation between fecal calprotectin and birth weight. Furthermore, there was moderate, significant correlation between fecal calprotectin and duration of breastfeeding range. On the other hand, there was no correlation between fecal calprotectin and post-natal age, gestational age, or volume of feeding. A cut-off at the 67.0μg/g level, with 100.0% sensitivity and 76.9% specificity, was considered. ConclusionFecal calprotectin level increased significantly in neonates with feeding intolerance; it can be used to detect early cases with necrotizing enterocolitis in neonates, but this subject still needs more investigations on more patients.

Is mode of delivery associated with the risk of necrotizing enterocolitis?

The pathogenesis of necrotizing enterocolitis remains poorly understood. Different newborn bacterial colonization due to cesarean delivery as opposed to vaginal delivery has been implicated as one potential contributing factor. We sought to determine whether mode of delivery is associated with the risk of necrotizing enterocolitis in neonates of womenwho were at imminent risk of delivery <32 weeks' gestational age. This is a secondary analysis of data from a randomized controlled trial of magnesium sulfate for the prevention of cerebral palsy. The parent trial included women with pregnancies at 24to 31 6/7 weeks of gestation who were considered at imminent riskfor preterm delivery. Women with a viable singleton gestation and data available on mode of delivery and development of necrotizing enterocolitis were included. Neonates delivered by vaginal delivery werecompared to those delivered by cesarean delivery in bivariable analyses. Multivariable analysis was used to adjust for potential confounders. A total of 2012 mother-neonate pairs were analyzed. Of these, 731 (36%) women delivered by cesarean delivery and 170 neonates (8.4%) developed necrotizing enterocolitis. In bivariable analyses, women who delivered by cesarean delivery were older (27 [interquartile range, 22-32] vs 24 [interquartile range, 20-29] years, P < .001) and had a higher frequency of chorioamnionitis (14.0% vs 10.5%, P= .021) compared to those who delivered vaginally. Neonates delivered by cesarean delivery were more premature (29.3 [interquartile range, 27.1-31.4] vs 30.3 [interquartile range, 27.9-31.9] weeks, P < .001), were smaller (1266 [interquartile range, 920-1643] vs 1465 [interquartile range, 1067-1850] g, P < .001), were more likely to be small for gestational age (4.4% vs 1.9%, P= .001), and had a higher frequency of proven sepsis (20.1% vs 14.7%, P= .002) compared to those who delivered vaginally. Rates of necrotizing enterocolitis (8.1% vs 8.7%, P=.65) and stage 2 or 3 necrotizing enterocolitis (4.4% vs 4.7%, P=.75) did not differ by mode of delivery. After adjusting for potential confounders, cesarean delivery continued to have no association with the frequency of necrotizing enterocolitis (adjusted odds ratio, 0.74; 95% confidence interval, 0.52-1.04) or stage 2 or 3 necrotizing enterocolitis (adjusted odds ratio, 0.73; 95% confidence interval, 0.46-1.16). This study was powered to detect a minimum relative risk of 1.5 for necrotizing enterocolitis associated with mode of delivery. Mode of delivery was not significantly associated with necrotizing enterocolitis in neonates born to a cohort of women who were considered at imminent risk of extreme preterm delivery.

Genetic Characterization of Cronobacter sakazakii Recovered from the Environmental Surveillance Samples During a Sporadic Case Investigation of Foodborne Illness.

Cronobacter sakazakii is an opportunistic human-pathogenic bacterium known to cause acute meningitis and necrotizing enterocolitis in neonates and immunocompromised individuals. This human-pathogenic microorganism has been isolated from a variety of food and environmental samples, and has been also linked to foodborne outbreaks associated with powdered infant formula (PIF). The U.S. Food and Drug Administration have a policy of zero tolerance of these organisms in PIF. Thus, this agency utilizes the presence of these microorganisms as one of the criteria in implementing regulatory actions and assessing adulteration of food products of public health importance. In this study, we recovered two isolates of Cronobacter from the 91 environmental swab samples during an investigation of sporadic case of foodborne illness following conventional microbiological protocols. The isolated typical colonies were identified using VITEK2 and real-time PCR protocols. The recovered Cronobacter isolates were then characterized for species identification by sequencing the 16S rRNA locus. Further, multilocus sequence typing (MLST) was accomplished characterizing seven known C. sakazakii-specific MLST loci (atpD, fusA, glnS, gltB, gyrB, infB, and pps). Results of this study confirmed all of the recovered Cronobacter isolates from the environmental swab samples to be C. sakazakii. The MLST profile matched with the published profile of the complex 31 of C. sakazakii. Thus, rRNA and 7-loci MLST-based sequencing protocols are robust techniques for rapid detection and differentiation of Cronobacter species, and these molecular diagnostic tools can be used in implementing successful surveillance program and in the control and prevention of foodborne illness.

Oral immunoglobulin for preventing necrotizing enterocolitis in preterm and low birth weight neonates.

Necrotizing enterocolitis (NEC) is the most common emergency involving the gastrointestinal tract occurring in the neonatal period. There have been published reports that suggest that oral immunoglobulins (Ig)A and IgG produce an immunoprotective effect in the gastrointestinal mucosa. To determine the effect of oral immunoglobulin on the incidence of necrotizing enterocolitis and other complications in preterm or low birth weight (or both) neonates. We used the standard search strategy of the Cochrane Neonatal Group. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2016, Issue 1), PubMed (1966 to January 2016), CINAHL (1982 to January 2016) and EMBASE (1980 to January 2016) and conference proceedings. All randomized or quasi-randomised controlled trials where oral immunoglobulins were used as prophylaxis against NEC in preterm (less than 37 weeks' gestation) or low birth weight (less than 2500 gram), or both, neonates. We performed data collection and analysis in accordance with the standard methods of the Cochrane Neonatal Review Group. The search identified five studies on oral immunoglobulin for the prevention of NEC of which three met the inclusion criteria. In this review of the three eligible trials (including 2095 neonates), the oral administration of IgG or an IgG/IgA combination did not result in a significant reduction in the incidence of definite NEC (typical risk ratio (RR) 0.84, 95% confidence interval (CI) 0.57 to 1.25; typical risk difference (RD) -0.01, 95% CI -0.03 to 0.01; 3 studies, 1840 infants), suspected NEC (RR 0.84, 95% CI 0.49 to 1.46; RD -0.01, 95% CI -0.02 to 0.01; 1 study, 1529 infants), need for surgery (typical RR 0.21, 95% CI 0.02 to 1.75; typical RD -0.03, 95% CI -0.06 to 0.00; 2 studies, 311 infants) or death from NEC (typical RR 1.10, 95% CI 0.47 to 2.59; typical RD 0.00, 95% CI -0.01 to 0.01; 3 studies, 1840 infants). Based on the available trials, the evidence does not support the administration of oral immunoglobulin for the prevention of NEC. There are no randomized controlled trials of oral IgA alone for the prevention of NEC.

517 Vagal Dysregulation and Female Sex Are Risk Factors for Necrotizing Enterocolitis in Preterm Neonates

517 Vagal Dysregulation and Female Sex Are Risk Factors for Necrotizing Enterocolitis in Preterm Neonates

Early hybrid approach and enteral feeding algorithm could reduce the incidence of necrotising enterocolitis in neonates with ductus-dependent systemic circulation.

The reported incidence of necrotising enterocolitis in neonates with complex CHD with ductus-dependent systemic circulation ranges from 6.8 to 13% despite surgical treatment; the overall mortality is between 25 and 97%. The incidence of gastrointestinal complications after hybrid palliation for neonates with ductus-dependent systemic circulation still has to be defined, but seems comparable with that following the Norwood procedure. We reviewed the incidence of gastrointestinal complications in a series of 42 consecutive neonates with ductus-dependent systemic circulation, who received early hybrid palliation associated with a standardised feeding protocol. The median age and birth weight at the time of surgery were 3 days (with a range from 1 to 10 days) and 3.07 kg (with a range from 1.5 to 4.5 kg), respectively. The median ICU length of stay was 7 days (1-70 days), and the median hospital length of stay was 16 days (6-70 days). The median duration of mechanical ventilation was 3 days. Hospital mortality was 16% (7/42). In the postoperative period, 26% of patients were subjected to early extubation, and all of them received treatment with systemic vasodilatory agents. Feeding was started 6 hours after extubation according to a dedicated feeding protocol. After treatment, none of our patients experienced any grade of necrotising enterocolitis or major gastrointestinal adverse events. Our experience indicates that the combination of an "early hybrid approach", systemic vasodilator therapy, and dedicated feeding protocol adherence could reduce the incidence of gastrointestinal complications in this group of neonates. Fast weaning from ventilatory support, which represents a part of our treatment strategy, could be associated with low incidence of necrotising enterocolitis.

Prevalence and Characterization of Cronobacter sakazakii in Retail Milk-Based Infant and Baby Foods in Shaanxi, China.

Cronobacter sakazakii (formerly Enterobacter sakazakii) is an opportunistic pathogen that causes meningitis, sepsis, and necrotizing enterocolitis in neonates and infants through consumption of contaminated milk-based foods. In this study, the prevalence of C. sakazakii in 705 retail milk-based infant and baby food samples was investigated in 12 cities in Shaanxi, China, in 2010 and 2012. One hundred and nineteen samples (16.9%) were C. sakazakii positive. The isolates were further characterized for antimicrobial susceptibility to 14 antibiotics, pulsed-field gel electrophoresis profiles, and presence of the virulence genes. Samples of brand W, Y, A, and G in 2010 and 2012 were C. sakazakii positive. All isolates recovered in 2010 and 2012 were susceptible to levofloxacin and cefoperazone. In 2012, no isolate was resistant to gentamicin, cefoxitin, chloramphenicol, gatifloxacin, ciprofloxacin, and ceftriaxone. Antibiotic resistance of the isolates was most commonly found to rifampicin, amoxicillin-clavulanic acid, streptomycin, tetracycline, and ampicillin in both 2010 and 2012, except to trimethoprim/sulfamethoxazole in 2012. Pulsed-field gel electrophoresis profiles indicated that C. sakazakii isolates were genotypically diverse, although these isolates were prevalent in infant and baby foods with the same brand. A total of 34 virulence gene profiles of the C. sakazakii isolates in 2010 and 2012 were detected. Isolates that co-carried hly-ompX-eitCBAD-iucABCD/iutA genes in 2012 were significantly (p < 0.05) more prevalent than those in 2010. The results added new epidemiological evidence for the widespread occurrence of C. sakazakii in retail milk-based infant and baby foods and this should be an indicator of potential health risk for consumers.

Role of oral probiotics in prevention of necrotising enterocolitis in preterm neonates in a tertiary care centre in Northern India

Background: Necrotising enterocolitis (NEC) is primarily a disease of premature infants, but may also be present in 10% of term and near term babies. It is the most common gastrointestinal (GI) medical/surgical emergency occurring in neonates. The objective was to study the r ole of oral probiotics in prevention of necrotising enterocolitis in preterm neonates. Methods: Prospective randomized controlled trial was done in tertiary care centre in Northern India for a period of 18 months. 300 preterm neonates, 150 in the test group and 150 in the control group were studied . The neonates in the test group were fed probiotics with breastmilk twice daily till they reached oral feeds. The neonates in the control group were fed breastmilk alone. Incidence and severity of NEC were measured. Results: 300 neonates (study group n = 150, control group n = 150) were randomized. The incidence of NEC was lower in test group (2.7%) than the control group (9.3%). The severity of NEC was reduced in test group (stage 2 and 3- 0.7%) than the control group (stage 2 and 3-6%). The mortality was also significantly lower in the intervention group (0% versus 20%). Conclusions: Probiotic supplementation has reduced the incidence and severity of necrotising enterocolitis in preterm neonates.

Evaluation of Cronobacter Growth and Phenotypic Variation Under Modified Culture Conditions.

Cronobacter sakazakii is an opportunistic pathogen known to cause acute meningitis and necrotizing enterocolitis in neonates and immunocompromised individuals. It has been isolated from a wide range of food and environmental samples, and has been linked to outbreaks associated with powdered infant formula. This study was carried out to assess variations in growth conditions (temperature, pH, and sugar supplement) and to establish how these changes impact phenotypic characteristics for successful recovery and identification of Cronobacter, particularly for routine surveillance purposes. A total of six Cronobacter isolates were tested to evaluate the above growth conditions, including three ATCC Cronobacter reference and three environmental isolates obtained from regulatory sample screening. Although only slight changes in colony-forming units were observed across the pH range and the sugars tested, the morphology was significantly impacted by changes in these growth factors. Incubation between 30 and 50 °C resulted in growth after 24 h, and the growth was slower at ambient temperature and colony formation was most robust at 30 °C. Results of this study suggest that 30 °C may be suitable for recovery of some Cronobacter strains, and minor variations in growth conditions can alter colony morphology and appearance. Expression of unique biological characteristics based on phenotypic observations may be beneficial for differentiating various Cronobacter strains.

Slow versus rapid enteral feed in preterm neonates with antenatal absent end diastolic flow

Objective: Incidence of feed intolerance (FI) and necrotizing enterocolitis (NEC) in preterm neonates with Doppler evidence of absent end diastolic flow (AEDF) velocities in the fetal umbilical artery when enteral feed volumes were started by 6–72 h and advanced either slowly or rapidly. Methods: Stable inborn neonates, 30–36 weeks gestation, weighing ≥1000 g and with antenatal evidence of AEDF were included in this pilot study. Infants (stratified in <1250 g and ≥1250 g birth weight categories) were allocated under randomized controlled trial, to receive either slow or rapid advancement of enteral feeding, while initiating the feeds after 6 h of birth if bowel sounds were present. Primary outcome measure was, FI and NEC till day 7 after reaching full feeds. Results: Of 159 eligible infants, 83 were randomized: 53 infants in the ≥1250 g category (28 in rapid and 25 in slow group) and 30 in the <1250 g category (15 in each group). FI was present in 11% versus 16% in ≥1250 g (p = 0.570) and 27% versus 33% in <1250 g (p = 0.690), NEC developed in 8.4% (3 versus 1) in ≥1250 g and (1 versus 2) in <1250 g, in slow versus rapid feeding. Conclusion: This trial did not find increase in incidence of feed intolerance with very early introduction and rapid advancement of enteral feeds in stable preterm neonates with AEDF and birth weight ≥1250 g.

Transcriptome analysis of Cronobacter sakazakii ATCC BAA-894 after interaction with human intestinal epithelial cell line HCT-8.

Cronobacter spp. are opportunistic pathogens that are responsible for infections including severe meningitis, septicemia, and necrotizing enterocolitis in neonates and infants. To date, questions still remain regarding the mechanisms of pathogenicity and virulence determinants for each bacterial strain. In this study, we established an in vitro model for Cronobacter sakazakii ATCC BAA-894 infection of HCT-8 human colorectal epithelial cells. The transcriptome profile of C. sakazakii ATCC BAA-894 after interaction with HCT-8 cells was determined using high-throughput whole-transcriptome sequencing (RNA sequencing (RNA-seq)). Gene expression profiles indicated that 139 genes were upregulated and 72 genes were downregulated in the adherent C. sakazakii ATCC BAA-894 strain on HCT-8 cells compared to the cultured bacteria in the cell-free medium. Expressions of some flagella genes and virulence factors involved in adherence were upregulated. High osmolarity and osmotic stress-associated genes were highly upregulated, as well as genes responsible for the synthesis of lipopolysaccharides and outer membrane proteins, iron acquisition systems, and glycerol and glycerophospholipid metabolism. In sum, our study provides further insight into the mechanisms underlying C. sakazakii pathogenesis in the human gastrointestinal tract.