Factor In Necrotizing Enterocolitis Research Articles

REGγ-mediated Barrier Disruption and NF-κB Activation Aggravates Intestinal Inflammation in Necrotizing Enterocolitis.

Necrotizing enterocolitis (NEC) stands as the most prevalent and severe gastrointestinal ailment affecting premature newborns, particularly those with extremely low birth weights. Intestinal barrier dysfunction emerges as a crucial factor in NEC's pathogenesis. REGγ predominantly manifests in the intestinal epithelium and has shown to regulate experimental colitis. However, the potential correlation between REGγ and NEC remains ambiguous. This study reveals that REGγ is notably overexpressed in both human and murine NEC samples. REGγ-deficient mice displayed improvements in intestinal mucosal inflammation and reduced NEC severity. Additionally, REGγ deficiency notably lowered the expression of phosphorylated transcription factor p65 and inflammatory factors in intestinal epithelial cells of NEC-afflicted mice. REGγ exacerbates the local inflammation by triggering the degradation of IκBɛ, a negative regulator of NFκB. Clinically, REGγ and p65 expression levels exhibit a positive correlation in NEC specimens. Moreover, pre-treatment of mice with a p65 inhibitor effectively suppressed the expression of inflammatory mediators and alleviated REGγ-mediated NEC development. These findings underscore that abnormal upregulation of REGγ triggers NEC development by enhancing NF-κB activity and exacerbating epithelial barrier dysfunction. Thus, novel therapeutic approaches targeting REGγ inhibition may offer enhanced treatment for NEC.

Association of neutrophil to lymphocyte ratio with preterm necrotizing enterocolitis: a retrospective case-control study

BackgroundThere have been few studies on the relationship between the neutrophil to lymphocyte ratio (NLR) and necrotizing enterocolitis (NEC). We conducted a retrospective case-control study to investigate this relationship in preterm neonates.MethodsA total of 199 preterm neonates diagnosed with NEC between January 2018 and January 2020 were included in this study. For each preterm infant with NEC that was admitted to the neonatal intensive care unit (NICU), controls were preterm neonates (matched for gestation and year of birth) who were not diagnosed with NEC. Exclusion criteria were post-maturity, small or large for gestational age (week of pregnancy), congenital major anomalies, and cyanotic congenital heart disease. Univariate and multivariate logistic regression analyses were used to identify the association between NLR and preterm NEC.ResultsThis study included 93 preterm neonates with NEC and 106 matched controls. There were no significant differences in gestational age (GA), birth weight (BW), age, sex, vaginal delivery (VD), chorioamnionitis (CA), and gestational diabetes mellitus (GDM) between the groups. Compared with the control group, the lower and higher NLR levels in the NEC group were statistically different. Following univariate analysis, NLR was a risk factor for NEC (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.00–1.90; P = 0.042), and according to multivariate analysis, risk factors for NEC were NLR ≥ 3.20 and NLR < 1.60, within 1 week before NEC diagnosis. Thus, NLR values of ≥ 1.60 and < 3.20 were determined as the predictive cut-off values for protecting preterm infants from NEC (Model I: OR, 0.20; 95% CI, 0.10–0.40; P < 0.001) and (Model II: OR, 0.10; 95% CI, 0.00–0.40; P < 0.001].ConclusionsNLR ≥ 1.60 and NLR < 3.20 were associated with a decreased risk of NEC in preterm infants.

Association Between Platelet-to-Lymphocyte Ratio and Preterm Necrotizing Enterocolitis.

Introduction: Necrotizing enterocolitis (NEC) is a fatal condition for very-low-birth-weight infants. Necrotizing enterocolitis is a multi-factor phenomenon that results in intestinal mucosal damage and leads to intestinal necrosis. However, sensitive laboratory indicators for NEC are lacking, making early diagnosis difficult. This study aimed to explore the relationship between the platelet-to-lymphocyte ratio (PLR) and NEC in preterm neonates to enable an earlier diagnosis of the condition.Methods: This was a retrospective case–control study of preterm neonates diagnosed with NEC between January 2018 and December 2019 in the West China Second University Hospital. Controls were selected from preterm neonatal intensive care unit (NICU) graduates, and they were matched for gestation and year of birth to the preterms diagnosed without NEC. In total, 93 and 107 infants were included in the NEC and control groups, respectively. Empowerstats analysis was used to identify the association between PLR and preterm NEC.Results: The NEC group had significantly higher PLR levels than the control group. PLR > 100 within 1 week before NEC diagnosis was a risk factor for NEC. There was a positive connection between PLR and preterm NEC. A PLR of >100 was determined as the optimal cutoff for predicting preterm NEC, with patients with PLR >100 having a higher risk of NEC [odds ratio (OR): 18.82 (95% confidence interval (CI): 2.93–120.98), p = 0.002].Conclusions: A PLR of >100 within 1 week after clinical abnormalities is associated with a high risk of NEC in preterm neonates.

Probiotics may not prevent the deterioration of necrotizing enterocolitis from stage I to II/III

BackgroundProbiotic therapy can reduce the incidence of NEC. Therapeutic use of probiotics after NEC diagnosis reduces the severity of NEC in preterm infants or full-term infants is unclear. To evaluate the effect of probiotics on preventing the deterioration of necrotizing enterocolitis (NEC) from stage I to II/III.MethodsA retrospective matched cohort study was performed. Included patients were ultimately divided into two groups: the probiotic treatment group (probiotics were used ≥4 days) and the no probiotic treatment group. The differences in deterioration trends between the two groups were compared. Additionally, the risk factors associated with the deterioration of NEC were further analyzed with a case-control study.ResultsA total of 231 infants met the inclusion criteria. Eighty-one pairs were matched according to similar gestational age and birth weight. Before matching, we found that the rate of deterioration of NEC from stage I to II/III in the group with probiotic treatment was similar to that in the group without probiotic treatment (23.1% [25/108] vs 26.0% [32/123], P = 0.614). After matching, the rate of deterioration of NEC between the two groups still had no significant difference (21.0% [17/81] vs 27.2% [22/81], P = 0.358). Logistic regression analysis showed that sepsis after NEC was an independent risk factor for NEC deteriorating from stage I to II/III (OR 2.378, 95% CI 1.005–5.628, P = 0.049).ConclusionProbiotics may not prevent the deterioration of NEC from stage I to II/III in infants, but this conclusion should be treated with caution.

Meconium-stained amniotic fluid as a risk factor for necrotizing enterocolitis in very low-birth weight preterm infants: a retrospective cohort study

Objective: To evaluate whether meconium-stained amniotic fluid (MSAF) is a risk factor for necrotizing enterocolitis (NEC) in very-low-birth-weight preterm infants.Materials and methods: The retrospective study was conducted at the Neonatal Diagnosis and Treatment Center of the Children’s Hospital of Chongqing Medical University from January 2010 to October 2016. The maternal and neonatal characteristics in cases of very low-birth weight infants born prior to 34 weeks of gestation were collected and compared between the MSAF and non-MSAF groups.Results: In the present study, 461 medical records of very low-birth-weight preterm infants were reviewed. A total of 41 (8.9%) infants were born to mothers with MSAF; in all, 180 infants were included in the study. Demographic characteristics and neonatal complications in the MSAF (n = 30) and non-MSAF groups (n = 150) were compared. A higher incidence of NEC (26.7% versus 10%, χ2 = 4.825, p = .028) was found in the MSAF group than in the non-MSAF group. Logistic regression analysis showed that MSAF (OR = 3.385, 95% CI: 1.349–8.492, p = .009) and sepsis (OR = 3.538, 95% CI: 1.442–8.679, p = .006) were independent risk factors for NEC.Conclusions: MSAF might be a risk factor for NEC in very-low-birth-weight infants. MSAF and sepsis contribute to the development of NEC.

Probiotics for prevention of necrotizing enterocolitis—where do we stand in 2017?

Necrotizing enterocolitis (NEC) affects primarily preterm infants and can lead to the devastating outcomes of intestinal failure secondary to resection of extensive necrotic bowel or death. A disordered intestinal microbiome is thought to be a risk factor for NEC. Probiotics are live microorganisms administered as food supplements or as pharmaceuticals in an attempt to improve human health. If the intestine of a preterm infant could be deliberately colonized with non-pathogenic organisms administered as a probiotic, the risk of NEC may decrease (1).

Neonatal necrotizing enterocolitis: Clinical data and treatment possibilities

Objectives. The aim of this paper is to identify the correlations between the clinical evolution of the neonates with necrotizing enterocolitis (NEC) and the stage of disease, associated risk factors and the type of treatment used. Material and methods. A 6 years retrospective study was performed based on reviewing the casuistry of the Regional Centre of Neonatal Intensive Care Unit (NICU) „Cuza Voda” and 205 cases of necrotizing enterocolitis were identified from a total number of 6183 neonates admitted there. Patients were divided in to study groups based on the gestational age (GA) and birth weight (BW). The analysis protocol was realized based on a working sheet that included the epidemiological data of the patients, the risk factors, type of nutrition, age at diagnosis, stage of disease according to Bell classification, type of treatment (medical, surgical or combined), complications and the general evolution. The statistical data processing was performed in SPSS Statistics 20 program. Results. NEC had a frequency of 3.3% is the study group and was diagnosed in premature newborns in 75.6% of cases. The mean GA for the study group was 33 weeks. The mean BW was 1896 g with 43% of the cases in very low birth weight (VLBW) group and 31.2% in low birth weight (LBW) group. The percentage incidence of the risk factors was as follows: persistence of ductus arteriosus 19.5%, perinatal asphyxia 13.7% and respiratory distress 100% of cases. 75.5% were treated and discharged from NICU, 16.6% were transferred to Pediatric Surgery Department „Sf. Maria” and 3.9% died in NICU. From the 34 cases transferred19 cases were surgically treated: 8 cases with peritoneal drainage (PD), 8 cases with primary laparotomy (LAP) and 3 cases with PD and LAP. The survival rate in this group was 2.4% and for the medically treated group was 4.9%. Conclusions. Prematurity is statistically correlated with encountering advanced stages of enterocolitis at the time of diagnosis. The option for surgical treatment (peritoneal drainage or laparotomy) does not influence the results and early enteral feeding with formula is the most important risk factor for NEC followed by age of gestation and very low birth weight.

Frequency of and risk factors for necrotizing enterocolitis in infants born before 33 weeks of gestation.

To investigate the frequency of and risk factors for necrotizing enterocolitis (NEC) among infants of <33 wk of gestation. Prospective follow-up of 140 inpatients. 26 (18.6%) subjects developed NEC stage I-III and 12 (8.6%) severe NEC (stage II-III). Breast milk fortifier and duration of morphine infusion emerged as the statistically significant factors associated with NEC stage I-III, but only the latter had a significant association with severe NEC. Future studies are needed to be established whether morphine is a causative factor in NEC.

Neonatal Deaths in the Asir Region of Saudi Arabia: Experience in a Referral Neonatal Intensive Care Unit

We reviewed a total of 169 deaths among 969 infants referred from various health institutions in the Asir Region to the neonatal intensive care unit of Asir Central Hospital, Abha, Saudi Arabia, during a four-year period (January 1992 to December 1995). The results showed that the major causes of neonatal mortality in the region were low birth weight (LBW) (45%), congenital malformations (CM) (30.8%), infection (13.6%), and birth asphyxia (7.7%). The majority of the LBW infants died from respiratory insufficiency, sepsis, and necrotizing enterocolitis. The alimentary, central nervous and cardiovascular systems were the parts most commonly involved in CM, with cardiac defect accounting for the highest fatality rate due to lack of facilities for cardiac surgery in the region, and delay in effecting a transfer. Klebsiella, Serratia and E. coli are the predominant organisms causing neonatal sepsis, in contrast with the group B streptococcus dominating in America and the United Kingdom. Generally, factors causing neonatal deaths in the Asir region are similar to those reported in other tertiary hospitals in Saudi Arabia, and tally closely with observations in America and Europe, where the standard of health care is excellent. Nevertheless, the study indicates the need for upgrading of facilities, as well as for more trained personnel for obstetric and neonatal care in Asir region. It may be necessary to consider the need for the establishment of a regional cardiac surgery center in the region.

The role of host factors in an outbreak of necrotizing enterocolitis.

During an outbreak investigation of necrotizing enterocolitis (NEC) in a neonatal intensive care unit, we identified nine definite and six suspected cases of NEC on the basis of histopathologic, clinical, and roentgenographic findings. Neonates of low birth weight (less than 1,250 g) had the highest incidence of NEC, supporting a role for prematurity in this disease. Patients with definite NEC and those with severe clinical features had significantly lower birth weights and postconception ages (gestational age at birth plus postnatal age at onset of NEC) than the patients with suspected NEC. In a case-control study using birth weight-matched control subjects, maternal toxemia was identified as a possible protective factor for NEC. To our knowledge, this is the first report of the relationship between NEC disease severity and postconception age. These findings also suggest that toxemia may be an important protective factor in NEC and should be examined in subsequent studies.