Enterocolitis In Term Infants Research Articles

Risk Factors for Adverse Outcomes in Term Infants with CHD and Definitive Necrotising Enterocolitis.

To define the incidence of definitive necrotising enterocolitis in term infants with CHD and identify risk factors for morbidity/mortality. We performed a 20-year (2000-2020) single-institution retrospective cohort study of term infants with CHD admitted to the Boston Children's Hospital cardiac ICU with necrotising enterocolitis (Bell's stage ≥ II). The primary outcome was a composite of in-hospital mortality and post-necrotising enterocolitis morbidity (need for extracorporeal membrane oxygenation, multisystem organ failure based on the paediatric sequential organ failure assessment score, and/or need for acute gastrointestinal intervention). Predictors included patient characteristics, cardiac diagnosis/interventions, feeding regimen, and severity measures. Of 3933 term infants with CHD, 2.1% (n = 82) developed necrotising enterocolitis, with 67% diagnosed post-cardiac intervention. Thirty (37%) met criteria for the primary outcome. In-hospital mortality occurred in 14 infants (17%), of which nine (11%) deaths were attributable to necrotising enterocolitis. Independent predictors of the primary outcome included moderate to severe systolic ventricular dysfunction (odds ratio 13.4,confidence intervals 1.13-159) and central line infections pre-necrotising enterocolitis diagnosis (odds ratio 17.7, confidence intervals 3.21-97.0) and mechanical ventilation post-necrotising enterocolitis diagnosis (odds ratio 13.5, confidence intervals 3.34-54.4). Single ventricle, ductal dependency, and feeding related factors were not independently associated with the primary outcome. The incidence of necrotising enterocolitis was 2.1% in term infants with CHD. Adverse outcomes occurred in greater than 30% of patients. Presence of systolic dysfunction and central line infections prior to diagnosis and need for mechanical ventilation after diagnosis of necrotising enterocolitis can inform risk triage and prognostic counseling for families.

Analysis of clinical characteristics of necrotizing enterocolitis in term infants

To investigate the characteristics and outcomes of necrotizing enterocolitis (NEC) in Chinese term infants population. A national neonatal necrotizing enterocolitis network was established. Neonates as having necrotizing enterocolitis with gestation age ≥37 weeks were identified if they met the accepted diagnostic criterion during the study period from Jan 1(st) 2011 to Dec 31(st) 2011. The data of maternal and neonates' characteristics, the comorbidities, the clinical interventions prior to NEC, the clinical courses and radiology results, the medical and surgical treatment and the outcomes were collected. SPSS 19.0 software was used to do statistic analysis. Logistic-regression models were used to analyze the risk factors for death in infants with NEC, odds ratio (OR) and 95% confidence interval (CI) were calculated. There were 231 067 newborn infants, 164 307 of them were term infants, admitted to 95 hospitals in main land China. There were 718 term infants were diagnosed as necrotizing enterocolitis with the incidence of 0.44%. There were 294 term infants cases identified as ≥stage 2 necrotizing enterocolitis for the analysis, including 193 cases of stage 2 and 101 cases of stage 3.The mean gestation age was (39.0±1.3) weeks, and the mean birth weight was(3 087.4±548.3)g. The percentage of small for gestation age was 20.4%. The onset age of NEC was 5 (2-11)d. The percentage of cases received breast milk feeding was 23.7%. The most common comorbidities were sepsis (9.5%, 28/294), asphyxia (9.5%, 28/294), pneumonia (7.8%, 23/294) and congenital megacolon (7.5%, 22/294). The bowel perforation rate was 13.9%. The rate of cases who received surgical treatment was 25.2%(76.6% small intestinal necrosis and 65.8% small intestinal perforation). The mortality rate was 28.9%(the mortality rate were 20.7% and 44.6% in stage 2 and stage 3 NEC, respectively). Noninvasive continuous positive airway pressure treatment for NEC (OR=5.278, 95% CI: 2.058-13.533, P<0.01) and NEC staging 3 (OR=3.156, 95% CI: 1.766-5.642, P<0.01) were statistically significantly associated with mortality of NEC. The term infants with necrotizing enterocolitis usually have the underlying comorbidities. The breastmilk feeding rate is low. Necrotizing enterocolitis remains high mortality in term neonates in Chinese neonatal units. Noninvasive continuous positive airway pressure treatment for NEC is statistically significantly associated with mortality of NEC.

Persistent Diastolic Flow Reversal in Abdominal Aortic Doppler-Flow Profiles Is Associated With an Increased Risk of Necrotizing Enterocolitis in Term Infants With Congenital Heart Disease

Persistent Diastolic Flow Reversal in Abdominal Aortic Doppler-Flow Profiles Is Associated With an Increased Risk of Necrotizing Enterocolitis in Term Infants With Congenital Heart Disease

Persistent Diastolic Flow Reversal in Abdominal Aortic Doppler-Flow Profiles Is Associated With an Increased Risk of Necrotizing Enterocolitis in Term Infants With Congenital Heart Disease

Diastolic runoff in the abdominal aorta, with subsequent circulatory mesenteric insufficiency, has been postulated as a cause of necrotizing enterocolitis in term infants with congenital heart disease. With this study we sought to determine whether Doppler-flow characteristics in the abdominal aorta can predict which infants are at specific risk, independent of gestational age and type of congenital heart disease. We conducted a case-control study of term infants with congenital heart disease and proven necrotizing enterocolitis (n = 18) compared with gestational age-matched and diagnosis-matched control subjects (n = 20). Abdominal aortic Doppler velocities, time intervals, and reversals were analyzed. Groups were compared, and independent risk factors for necrotizing enterocolitis were determined. The groups were similar with regard to weight, pulse pressure, use of prostaglandins or inotropes, presence of a patent ductus arteriosus, and systolic function. However, 47% of the case subjects with necrotizing enterocolitis had persistent retrograde diastolic flow in the abdominal aorta compared with 15% of the control subjects. When adjusting for multiple risk factors, persistent diastolic flow reversal remained the only factor significantly associated with necrotizing enterocolitis. Persistent diastolic flow reversal in the abdominal aortic Doppler profile is associated with an increased risk of necrotizing enterocolitis in term infants with congenital heart disease irrespective of gestational age or anatomic type of congenital heart disease.

A cluster of necrotizing enterocolitis in term infants undergoing open heart surgery

Background: Necrotizing enterocolitis (NEC) is a serious gastrointestinal disease of unknown cause that predominantly affects premature infants, but it has been reported in term infants with congenital heart disease.Methods: In August and September of 1997, 4 cases of NEC in term infants with congenital heart disease were identified among 24 infants undergoing cardiac surgical procedures at our institution. Because nosocomial NEC had not previously been identified among infants in our pediatric intensive care unit, a case-control study was conducted to identify risk factors for NEC. All infants less than 4 months old undergoing cardiac surgery without development of NEC during the epidemic period were selected as controls.Results: The only significant risk factor associated with case-infants was a higher mean temperature gradient (rectal/toe) during the immediate 12-hour postoperative period (4.0°C vs 2.0°C, P < .01). Urine output was higher in control-infants in this postoperative period, although not statistically significant (11.9 mL/h vs 6.1 mL/h, P = .15).Conclusion: Although an infectious etiology cannot be ruled out, the cases of NEC in infants with congenital heart disease after cardiac procedures may have resulted from mesenteric ischemia associated with a low perfusion state in the perioperative period.

A cluster of necrotizing enterocolitis in term infants undergoing open heart surgery

Necrotizing enterocolitis (NEC) is a serious gastrointestinal disease of unknown cause that predominantly affects premature infants, but it has been reported in term infants with congenital heart disease. In August and September of 1997, 4 cases of NEC in term infants with congenital heart disease were identified among 24 infants undergoing cardiac surgical procedures at our institution. Because nosocomial NEC had not previously been identified among infants in our pediatric intensive care unit, a case-control study was conducted to identify risk factors for NEC. All infants less than 4 months old undergoing cardiac surgery without development of NEC during the epidemic period were selected as controls. The only significant risk factor associated with case-infants was a higher mean temperature gradient (rectal/toe) during the immediate 12-hour postoperative period (4.0 degrees C vs 2.0 degrees C, P <.01). Urine output was higher in control-infants in this postoperative period, although not statistically significant (11.9 mL/h vs 6.1 mL/h, P =.15). Although an infectious etiology cannot be ruled out, the cases of NEC in infants with congenital heart disease after cardiac procedures may have resulted from mesenteric ischemia associated with a low perfusion state in the perioperative period.

Necrotizing enterocolitis in term infants: S. Silberman, R. Udassin, O. Zamir, et al. Pediatr Surg Int 4:35–38, (December), 1988

Necrotizing enterocolitis in term infants: S. Silberman, R. Udassin, O. Zamir, et al. Pediatr Surg Int 4:35–38, (December), 1988

Myelomeningocele: a risk factor for necrotizing enterocolitis in term infants.

Myelomeningocele: a risk factor for necrotizing enterocolitis in term infants.

Necrotizing enterocolitis in term infants

Nine term infants developed necrotizing enterocolitis (NEC) at a mean age of \(3{\raise0.5ex\hbox{$\scriptstyle 3$}\kern-0.1em/\kern-0.15em\lower0.25ex\hbox{$\scriptstyle 4$}}\) months. In six, NEC developed following severe diarrhea. One infant had major congenital heart disease. Two were in apparently good health before developing rapidly progressing NEC. Two infants died before operation was feasible, one survived without an operation, and only 1 of 6 infants survived following surgical treatment. Awareness that NEC can occur in term infants may enable early diagnosis and treatment and may reduce the high mortality associated with this uncommon disease.

Necrotizing enterocolitis in term infants

Despite the fact that necrotizing enterocolitis is considered a disease of premature infants, 20% of all affected infants at Babies Hospital over the past 20 years were products of term gestations. Two distinct subgroups of such infants were noted (1) five infants with congenital heart disease and/or congestive heart failure (e.g.hypoplastic left heart syndrome), all but one of whom developed the disease in the first week of life; (2) eight infants who developed the disease at a much later age after a protracted period of diarrhea. This histopathologic features of the disease in term infants are the same as those in premature infants. Further, the pathogenesis of the disease in term infants does not appear to differ basically from that in premature infants. These facts, lead away from the concept of NEC as a disease of simple etiology.