Incidence Of NEC Research Articles

Online registry of neonatal necrotising enterocolitis in Shenzhen: protocol for a multicentre, prospective, open, observational cohort study

IntroductionNecrotising enterocolitis (NEC) of the intestine of preterm infants leads to the risk of abdominal surgery, short bowel syndrome, neurodevelopmental disorders and death. Although the risks of NEC and its...

Comparing the Effects of Two Surfactant Administration Methods: Minimally Invasive Surfactant Therapy (MIST) with Intubation (INSURE) in Infants with Respiratory Distress Syndrome.

The aim of this study is to investigate and compare the effects of administering a surfactant through a fine intra-tracheal catheter during spontaneous breathing with the usual INSURE method in premature infants. In this clinical trial, premature babies with respiratory distress syndrome who required surfactant administration were randomly assigned to two groups: an intervention group (MIST) and a control group (INSURE). The treatment results were compared in terms of complications related to treatment (desaturation, apnea, bradycardia, and surfactant reflux), respiratory complications (requirement for mechanical ventilation, duration of nCPAP, duration of oxygen requirement, frequency of pneumothorax, and pulmonary hemorrhage), complications related to prematurity (incidence of IVH, NEC, BPD, and PDA), the need for a second dose of surfactant, and the duration of hospitalization. a total of 160 premature babies with a gestational age of 26-34 weeks were randomly divided into two groups. The results showed that the need for mechanical ventilation, the duration of CPAP needed, and the duration of oxygen therapy were significantly lower in the MIST group than in the INSURE group. Additionally, the incidence of BPD was less common in the MIST group compared to the INSURE group. However, surfactant reflux was more common in the MIST group than in the INSURE group. There were no significant differences between the two groups in other outcomes, including the length of hospital stay and complications such as IVH, PDA, NEC, pneumothorax, and pulmonary hemorrhage. The results of this research demonstrate that the less invasive method of surfactant therapy (MIST) is a feasible, effective, and low-risk alternative to the INSURE method.

Maternal chorioamnionitis and the risk for necrotizing enterocolitis in the United States: A national cohort study

BackgroundNecrotizing enterocolitis (NEC) is a major cause for morbidity and mortality among newborn infants. Chorioamnionitis is a perinatal complication that is associated with preterm delivery. Few reports have studied chorioamnionitis as a possible risk factor for NEC. Further investigation is needed to fully understand this association. ObjectiveTo examine the association of chorioamnionitis with NEC in newborn infants. MethodsWe used National Inpatient Sample (NIS) datasets produced by the federal Healthcare Cost and Utilization Project (HCUP). We identified infants born to mothers diagnosed with chorioamnionitis and infants born to mothers who did not have chorioamnionitis. The odds ratios (OR) to develop NEC in infants born to mothers affected by chorioamnionitis were calculated using chi square and Fisher Exact tests in the overall sample and in subgroups of different birthweight (BW) categories. The association was re-evaluated using logistic regression models to control for confounding variables. ResultsThe study identified 18,973,800 newborn infants admitted during the years 2016–2020. Among infants born to mothers with chorioamnionitis, NEC occurred in 0.9 % compared to 0.1 % in infants born to mothers without chorioamnionitis, (adjusted OR = 1.12, CI:1.02–1.15, p = 0.01). The prevalence of NEC in infants born to mothers with chorioamnionitis varied by the birth weight category, mainly for BW category 2500-4499 g (aOR = 1.61, CI:1.44–1.80, p < 0.001). ConclusionMaternal chorioamnionitis is associated with increased incidence of NEC, particularly in the BW category 2500-4499 g. Further studies are needed to examine the pathophysiological factors underlying this association.

Efficacy of antenatal magnesium sulfate in the prevention of necrotizing enterocolitis: A randomized case-control study in preterm neonates.

Objective: To assess the efficacy of administering antenatal magnesium sulfate in reducing the occurrence of necrotizing enterocolitis in preterm infants. Study Design: Randomized Case-control study. Setting: Hameed Latif Hospital Lahore. Period: August 2023- February 2024. Methods: The study including 80 preterm neonates (26 to 32 weeks gestation) was conducted at Neonatology &amp; Gynaecology Unit Hameed Latif Hospital, Lahore. These neonates were divided into two groups: Group A included infants whose mothers were given magnesium sulfate before preterm birth, while Group B comprised of infants whose mothers did not receive magnesium sulfate. The primary outcome was the incidence of NEC in infants born to mothers exposed to magnesium sulfate, with secondary outcomes covering other neonatal morbidities and maternal side effects. Data analysis utilized SPSS Statistics software version 24, employing t-tests and multivariate logistic regression to evaluate the association between antenatal magnesium sulfate exposure and NEC incidence, considering a significant p-value of ≤ 0.05. Results: The overall NEC incidence was 5%(n=2). No NEC cases were reported in the control group. The difference in neonatal outcomes between both groups was statistically insignificant (p&gt;0.05). Conclusion: Administering antenatal magnesium sulfate has no effect in decreasing the incidence of NEC in preterm infants.

Immediate fortification of human milk with a bovine milk-derived human milk fortifier in very low birth weight infants: a randomized clinical trial

ObjectiveDouble-blind randomized control trial of early addition of a bovine milk-derived human milk fortifier (HMF) in very low birth weight (VLBW) infants (NCT05228535).MethodsVLBW infants were randomized to receive bovine milk-derived HMF with first feedings or delayed fortification at 80 ml/kg/day. Anthropometrics were assessed weekly through 36 weeks postmenstrual age (PMA). Unadjusted and adjusted (race, gender, gestational age, and birth weight) differences between study arms were examined using two-sample t-test and ANCOVA, respectively.ResultsFifty-two VLBW infants (57% female, 60% Black) were enrolled. Baseline demographics did not differ between groups. Weight velocity at DOL 28 did not differ between study arms. Secondary outcomes including NPO occurrence, incidence of metabolic acidosis, NEC, retinopathy, or late-onset sepsis did not differ between groups.ConclusionImmediate fortification of enteral feedings with a bovine milk-derived HMF appears safe and well-tolerated although no clear growth benefit could be established.

Early enteral nutrition with exclusive donor milk instead of formula milk affects the time of full enteral feeding for very low birth weight infants.

This study investigated the effects of exclusive donor milk or formula in the first 7 days after birth, on the time to full enteral feeding, growth, and morbidity of adverse events related to premature infants. This was a retrospective study carried out from July 2014 to December 2019 at the Department of Neonatology of Shanghai Children's Hospital. All infants with a birth weight < 1,500 g and a gestational age ≤ 32 who received exclusive donor milk or formula in the first 7 days after birth were included in this study. The time to full enteral feeding (defined as 150 mL/kg) in the donor milk group was significantly shorter than in the formula group (18 vs. 22 days, p = 0.01). Donated breast milk was also associated with a lower incidence of NEC (4.4 vs. 7%, p < 0.01), ROP (3.8 vs. 13.2%, p < 0.01), and culture-confirmed sepsis (11 vs. 22.6%, p < 0.01). Using donated breast milk instead of current formula milk for early enteral nutrition can shorten the time to full enteral feeding and reduce the incidence of NEC, ROP, and sepsis.

Operation Status of the Mutual Aid Human Milk Bank for Preterm Infants and Data Analysis.

This study aimed to investigate the matching degree between the donated supply and demand, clinical characteristics of both donors and recipients, along with the operation cost. From January 1, 2018 to December 31, 2021, the data on human milk donation and usage, the clinical characteristics of donors and recipients, and the cost of each operating center were collected from the Manual Donation Registration Form and Information Management System of the selected human milk bank. During the four years that the human milk bank was in operation, the volume of donated milk was slightly greater than the volume of consumed milk. A total of 1364 donors donated 2434.63 liters of qualified human milk, for RMB 1,791,000 (USD 257, 202), ie, RMB 385.3 (USD 55.3)/L; 97.8% of the donors were preterm puerperae, and 59% of the donors donated between 1 week and 1 month after delivery. All recipients were preterm infants and received donated human milk for a duration of 9.4 days on average. During the four years of operation, the proportion of donors who had previously received donated milk among all donors showed an overall increasing trend, while the incidence of NEC in preterm infants gradually decreased. The increasingly optimized structure of donors, the more economical operation, and the fact that the use of donated milk may not affect breastfeeding of the recipients have made it a human milk bank operation mode worthy of promotion.

Assessment of food supplements for the prevention of necrotizing enterocolitis in preterm neonates: A systematic review and network meta-analysis

Background:The network meta-analysis (NMA) investigated the efficacy of six food supplements, namely glutamine, arginine, lactoferrin, prebiotics, synbiotics, and probiotics, in preventing necrotizing enterocolitis in premature infants. Methods:MEDLINE, Embase, and Cochrane Library were searched. Randomized controlled trials comparing different food supplements for premature infants were included. Results:Probiotics (OR, 0.47; 95% CrI, 0.33–0.63), arginine (OR, 0.38; 95% CrI, 0.14–0.98), glutamine (OR, 0.30; 95% CrI, 0.079–0.90), and synbiotics (OR, 0.13; 95% CrI, 0.037–0.37). were associated with a decreased incidence of NEC. Only probiotics (OR, 0.81; 95% CrI, 0.69–0.95) and lactoferrin (OR, 0.74; 95% CrI, 0.54–0.92) achieved lower risk of sepsis. Probiotics (OR, 0.58; 95% CrI, 0.40–0.79), prebiotics (OR, 0.23; 95% CrI, 0.043–0.86), and synbiotics (OR, 0.15; 95% CrI, 0.035–0.50) were associated with lower odds of mortality. Probiotics (MD, -2.3; 95% CrI: -3.7– -0.63) appeared to have earlier age of attainment of full feeding. Conclusions:Based on this NMA, probiotics and synbiotics had the potential to be the top two preferable food supplements.

Cumulative Dose of Prostaglandin E1 Determines Gastrointestinal Adverse Effects in Term and Near-Term Neonates Awaiting Cardiac Surgery: A Retrospective Cohort Study.

This study aimed to assess the association between treatment characteristics of prostaglandin E1 including initiation time and duration, maximal and cumulative doses, and adverse effects. A retrospective cohort study in which medical records of neonates with duct-dependent lesions were studied for treatment parameters and adverse effects. Multivariable logistic regression model was applied for testing the effect PGE1 variables on outcomes. The primary outcomes of this study were association of adverse effects of PGE1 treatment with maximal dose, cumulative dose, and treatment duration. The secondary outcomes included safety of feeding in infants treated with PGE1. Eighty-two infants with duct-dependent lesions receiving PGE1 were included. Several infants who received early PGE1 treatment required ventilation support. Feeds were ceased more often as the cumulative dose and duration of PGE1 treatment increased. Gastrointestinal adverse effects were significantly associated with the cumulative dose of PGE1 and treatment duration. Apneas, hyperthermia, and tachycardia were associated with maximal dose. Our data did not demonstrate a difference in the incidence of NEC associated with characteristics of PGE1 treatment. Cumulative PGE1 dose is associated with gastrointestinal adverse effects in neonates. Lower doses should be considered in neonates expecting prolonged PGE1 treatment.

Early versus Late Enteral Feeding in Preterm Intrauterine Growth Restricted Neonates with Antenatal Doppler Abnormalities

Background: Placental insufficiency and decreased placental nutrition transfer from the mother to the fetus are the underlying causes of intra-uterine growth restriction (IUGR), a serious and very frequent issue in the perinatal period. Due to a lack of recent research in the area, the current study aims to compare the outcomes of two different feeding strategies for preterm infants with abnormal Doppler readings: early vs. delayed initiation of enteral feeds. Then we implement the better of the two feedings regimens into our standard clinical practice. Objective: The objective of the study was to compare early and late enteral feeding in preterm intrauterine growth restricted neonate to evaluate time to reach full feed, risk of feed Intolerance, weight gain at 10th day of life and length of hospital stays. Study Design: The Randomized Control Trial. Settings: This study was conducted in the neonatology department Tertiary Care Hospital (Nursery MCH Centre, Pakistan Institute of Medical Sciences, Islamabad Pakistan. Duration: 1st June 2022 to 1st December 2022. Methods: The sample was collected from the by non-probability consecutive sampling technique. Babies of any sex who meet the requirements during the first 72 hours of life. A total of 80 newborns were recruited out of them n=40 infants were found as early feeding and n=40 was assigned to late feeding. Demographic and baseline information (admission date, age, gender, gestational age, birth weight) of enrolled neonates recorded in the prescribed proforma. Effects of early or late feeding were monitored daily for 10 days. The outcomes in terms of time to reach full feed, weight gain at 10th day of life and feed intolerance were recorded and compared in both groups. All the information entered on the predesigned proforma by the researcher himself to comply with the study protocol attached. Results: A total of 80 newborns were recruited out of them n=40 infants were found as early feeding and n=40 was assigned to late feeding. The base line characteristics including birth weight, gestational age, respiratory support etc. were not statistically significant. Also, there is no difference of NEC (0.267) and FI (0.312) in early and late feeding groups. The Cox regression HR: 1.21 (95% CI: 0.829-3.72); p = 0.326). In both groups, the early feeding arm had a shorter median duration by 7 days. Further, the data was compared between early and late feeding group to determined which group is quicker for discontinuation of PN. Conclusion: Our study finds that using the feeding initiation and advancement method and AREDF on Doppler with exclusive breast milk results in faster PN cessation and does not increase the incidence of NEC or FI in preterm IUGR infants between 27 and 33 weeks of age.

The Relationship Between Enteral and Parenteral Nutrition on Body Weight, Incidence of NEC, Sepsis and Length of Care for Preterm Infant in Dr. Soetomo General Hospital Surabaya

The incidence of preterm birth in Indonesia still accounts for the highest mortality rate. Failure to provide adequate nutrition will have an impact on growth failure, risk of infection and longer duration of care for preterm infant. This study aims to analyzing the relationship between enteral and parenteral nutrition on body weight, the incidence of NEC, the incidence of sepsis and the length of care at Dr. Soetomo Hospital Surabaya. A total 106 subjects were enrolled, 78 infants were LBW, 19 infants were VLBW. Gestational age between 32-<37 weeks as many as 96 subjects. 68 infants were female. A total of 49 patients (46.2%) received parenteral nutrition. There is a relationship between enteral nutrition and the incidence of sepsis (p= 0.03), parenteral nutrition and body weight (p= 0.005), parenteral nutrition and the incidence of sepsis (p= 0.001), and parenteral nutrition and the length of care for preterm infants (p= 0.001). There is a relationship between enteral nutrition with the incidence of sepsis and parenteral nutrition with body weight, incidence of sepsis and length of care in preterm infants.

Admission temperature and neonatal outcomes - single-centre experience in Saudi Arabia

This study aimed to investigate the association between admission hypothermia (AH), neonatal mortality and major neonatal morbidities in preterm infants <33 weeks' gestation. An additional aim of the study was to examine changes in the prevalence of admission hypothermia after the initiation of a thermoregulation quality improvement (QI) project. This is a retrospective cohort study of preterm infants < 33 weeks' gestation born at King AbdulAziz Medical City Riyadh (KAMC-R) between January 2017 to December 2020. Eight-hundred infants were born during the study period. Four hundred and one infants (50.1%) had an admission temperature of <36.5°C and a further 399 (49.9%) had an admission temperature of >36.5°C. The mortality before discharge was 15.7% in infants with AH compared to 4.8% among those with an admission temperature above 36.5°C. This remained statistically significant after adjustments for gestational age and maternal PET status on a multivariate analysis (P=.001, OR 2.7,95%CI 1.5-4.7). The need for mechanical ventilation (P=.005) and incidence of surgical NEC (P=.030) were significantly different between the two temperature groups. Mean (SD) admission temperature increased from 36.3°C to 36.6°C following the thermoregulation intervention program (P <.001). Admission temperature <36°C is associated with higher mortality in the first week (P=.001, OR 3.3,95% CI (1.7-6.6)) and increased incidence of cystic PVL (P=.04, OR 2.1, CI (1.03-4.3)). Preterm infants with AH suffered higher mortality and greater neonatal morbidities.

Care practices and short-term clinical outcomes of very low birth weight infants in Yangtze River Delta in China

BackgroundIntensive care is of great significance for very low birth weight infants (VLBWI). The Yangtze River Delta is the most ecomonically developed area in China. However, there are few data on the care practices and survival of VLBWI in this region.ObjectivesTo investigate the prevalence, care practices and motality of VLBWI in Yangtze River Delta in China.MethodsA multi-center retrospective investigation study was conducted at five tertiary hospitals within the Yangtze River Delta in China from January to December 2017. Clinical data included the general characteristics of the infants and the mothers, clinical prognosis, care practices in NICUs was collected by trained research members.ResultsDuring the study period, 1059 VLBWIs were included. Infants with birth weight < 750 g, 750-1000 g, 1000-1250 g and 1250-1500 g accounted for 2.3, 14.9, 34.8 and 47.8%, respectively. Premature rupture of membranes (17.8%) was the main cause of premature delivery. The catheterization rates of umbilical vein catheterization (UVC) and peripherally inserted central catheter (PICC) were 25.0 and 64.4%, respectively. The duration of parenteral nutrition was 27.0 ± 19.5 d, the meantime of feeding tube indwelling was 36.2 ± 24.2 d. The corrected gestational age of the infants who reached full oral feeding was 35.8 ± 2.7 weeks. The breast feeding rate in the investigated infants was 61.9%. The mortality rate of preterm infants was 3.4%. The incidence of main complications BPD, PDA, ROP, NEC and sepsis were 24.9, 29.9, 21.7, 9.4 and 13.3% respectively.ConclusionsMaternal and infant care practices need to be improved in the very preterm births. This study provides a baseline for the improvement in the further study.

Effect of duration of delayed cord clamping on serum bilirubin hematocrit and hemodynamic status in neonates

Introduction:DCC is a common practice with several benefits. The benefits of DCC are decreased risk of anemia, less incidence of periventricular leukomalacia, less incidence of NEC. This study tries to compare the effect of different duration of delayed cord clamping on serum bilirubin, hematocrit and hemodynamic status of a neonate. Material and method:A prospective study was done over a span of one year comprising of 150 full term neonates. After obtaining consent prior before delivary females who met the inclusion criteria were randomly assigned to 3 groups.For group 1 the cord was clamped at a duration of 30 sec, 60 sec for group 2 and 120 sec for group 3. Exact time of delayed clamping was recorded using a stop watch. Serum bilirubin and hematocrit level and parameters like respiratory rate, pulse rate, capillary refill time and temperature was assessed at day three. Results: Group 1 showed a mean hematocrit % of 41.51 (SD 10.28). Group 2 showed mean hematocrit % of 45.11 (9.4) and mean hematocrit % of group 3 was 45.64 (8.37).

Effect of standardized vs. local preoperative enteral feeding practice on the incidence of NEC in infants with duct dependent lesions: Protocol for a randomized control trial.

BackgroundInfants with duct dependent heart lesions often require invasive procedures during the neonatal or early infancy period. These patients remain a challenge for pediatric cardiologists, neonatologists, and intensive care unit personnel. A relevant portion of these infant suffer from respiratory, cardiac failure and may develop NEC, which leads to inadequate growth and nutrition, causing delayed or complicated cardiac surgery.MethodsThis randomized control trial will recruit term infants diagnosed with a duct dependant lesion within the first 72 h of life. After obtaining written parental consent patients will be randomized to either the physician led enteral feeding or protocol-based feeding group. The intervention will continue up to 28 days of life or day of cardiosurgical treatment, whichever comes first. The primary outcomes include NEC and death related to NEC. Secondary outcomes include among others, number of interrupted feedings, growth velocity, daily protein and caloric intake, days to reach full enteral feeding and on mechanical ventilation.DiscussionOur study will be the first randomized control trial to evaluate if standard (as in healthy newborns) initiation and advancement of enteral feeding is safe, improves short term outcomes and does not increase the risk of NEC. If the studied feeding regime proves to be intact, swift implementation and advancement of enteral nutrition may become a recommendation.Trial registrationThe study protocol has been approved by the local ethical board. It is registered at ClinicalTrials.gov NCT05117164.

Efficacy of Donated Milk in Early Nutrition of Preterm Infants: A Meta-Analysis.

Background: Preterm birth is associated with an increased risk of many complications, which is a main public health problem worldwide with social and economic consequences. Human milk from breast feeding has been proved to be the optimal nutrition strategy for preterm infants when available. However, the lack of human milk from mothers makes formula widely used in clinical practice. In recent years, donated breast milk has gained popularity as an alternative choice which can provide human milk oligosaccharides and other bioactive substances. Objective: We aimed to conduct a systematic review and meta-analysis to evaluate the nutritional effects of donated breast milk on preterm infants compared with formula. Method: In the present study, we searched Medline, Web of Science, Embase, clinicaltrials.gov, the China national knowledge infrastructure, and the Cochrane central register of controlled trials for candidate randomized controlled trials (RCTs). Results: A total of 1390 patients were enrolled in 11 RCTs and meta-analysis results showed that donated breast milk is also more advantageous in reducing the incidence of necrotizing enterocolitis (NEC, RR = 0.67, 95% CI = 0.48 to 0.93, p = 0.02), reducing the duration of parenteral nutrition (MD = −2.39, 95% CI = −3.66 to −1.13, p = 0.0002) and the time of full enteral feeding (MD = −0.33, 95% CI = −3.23 to 2.57, p = 0.0002). In comparison, formula significantly promotes the growth of premature infants, including their weight gain (MD = −3.45, 95% CI = −3.68 to −3.21, p < 0.00001), head growth (MD = −0.07, 95% CI = −0.08 to −0.06, p < 0.00001) and body length (MD = −0.13, 95% CI = −0.15 to −0.11, p < 0.00001), and reduces the time it takes for premature infants to regain birth weight (MD = 6.60, 95% CI = 6.11 to 7.08, p < 0.00001. Conclusion: Compared with formula, donated breast milk could significantly reduce the incidence of NEC, the duration of parenteral nutrition, and the time of full enteral feeding. Adding fortifiers in donated milk could make it as effective as formula in promoting the physical growth of premature infants.

Rapid versus Slow Feeding Advancement in Preterm Low Birth Weight Neonates: A Systematic Review and Meta-analysis

Objectives. To compare the clinical outcomes of rapid versus slow enteral feeding advancement in preterm low birth weight neonates.&#x0D; Methods. Searches for randomized controlled trials evaluating the effect of rapid versus slow rate of enteral feeding advancement on the clinical outcomes of preterm, low birth weight neonates were performed in different databases. Two authors screened the articles for inclusion and statistical analysis was done using Review Manager Version 5.3 (RevMan) software.&#x0D; Results. Six trials with a total of 680 subjects comparing enteral feeding advancement protocols were identified. The number of days to reach full feeds in rapid enteral feeding was shorter by 2.79 days (95% CI 1.39, 4.19) and time to regain weight by 3.72 days (95% CI 2.86, 4.59) compared to slow enteral feeding. There was no significant difference in the incidence of feeding intolerance (OR 0.69, 95% CI 0.42, 1.11) and NEC (OR 0.88, 95% CI 0.45, 1.72) between the two groups.&#x0D; Conclusions. Rapid enteral feeding protocols reduce the time to establish full enteral feeds and to regain birth weight in preterm low birth weight neonates. Rapid enteral feeding may facilitate early discharge and help reduce hospital costs for the care of these neonates.

Early erythropoietin for preventing necrotizing enterocolitis in preterm neonates - an updated meta-analysis.

There is moderate to low-quality evidence that early prophylactic EPO reduces any stage and ≥ Stage II NEC in preterm neonates. Prospectively registered, adequately powered, double-blind RCTs are required to confirm these findings. • Experimental studies have shown that erythropoietin (EPO) has gastrointestinal trophic effects. • Systematic reviews have shown that early treatment with EPO may decrease the risk of gut injury in preterm or low birth weight infants. • Early EPO supplementation significantly reduced the incidence of any stage NEC and definite NEC in preterm infants < 34 weeks of gestation. • EPO had no significant effect on definite NEC in the analyses that included only double-blinded and prospectively registered RCTs. How might it impact clinical practice in the foreseeable future? • Early prophylactic EPO can be recommended for NEC prevention if its benefits are consistently demonstrated in adequately powered randomized trials with a low risk of bias.

Risk Factors for Mortality From Late-Onset Sepsis Among Preterm Very-Low-Birthweight Infants: A Single-Center Cohort Study From Singapore.

ObjectiveTo determine the risk factors for mortality associated with late onset sepsis (LOS) among preterm very-low-birthweight (VLBW) infants.Study DesignWe performed a retrospective cohort study of infants born <32 weeks gestation and <1,500 gm admitted to a Singaporean tertiary-level neonatal intensive care unit. We determined the clinical, microbial, and laboratory risk factors associated with mortality due to culture-positive LOS in this cohort.ResultsA total of 1,740 infants were admitted, of which 169 (9.7%) developed LOS and 27 (16%) died. Compared to survivors, those who died had lower birth gestational age (median 24 vs. 25 weeks, p = 0.02) and earlier LOS occurrence (median 10 vs. 17 days, p = 0.007). There was no difference in the incidence of meningitis (11.1 vs. 16.9%, p = 0.3), NEC (18.5 vs. 14.8%, p = 0.6), or intestinal surgery (18.5 vs. 23.3%, p = 0.6) among infants who died compared to survivors. Gram-negative bacteria accounted for 21/27 (77.8%) LOS-associated deaths and almost all (13/14, 93%) fulminant episodes. The presence of multiorgan failure, as evidenced by the need for mechanical ventilation (100 vs. 79.0%, p = 0.008), elevated lactate (12.4 vs. 2.1 mmol/L, p < 0.001), and inotropic support (92.6 vs. 37.5%, p < 0.001), was significantly associated with mortality. Infants who died had significantly lower white blood cell (WBC) counts (median 4.2 × 109/L vs. 9.9 × 109/L, p = 0.001), lower platelet count (median 40 × 109/L vs. 62 × 109/L, p = 0.01), and higher immature to total neutrophil (I: T) ratio (0.2 vs. 0.1, p = 0.002). Inotrope requirement [AOR 22.4 (95%CI 2.9, 103.7)], WBC <4 × 109/L [AOR 4.7 (1.7, 13.2)], and I: T ratio >0.3 [AOR 3.6 (1.3, 9.7)] were independently associated with LOS mortality.ConclusionsIn a setting with predominantly Gram-negative bacterial infections, the need for inotropic support, leukopenia, and elevated I: T ratio were significantly associated with LOS mortality among preterm VLBW infants.

Rotavirus infection in newborn: A rare case of necrotizing enterocolitis

Rotavirus infections in neonates are often asymptomatic, but they can become complicated, up to Necrotizing Enterocolitis. Aim of the study is to resume the history of a rare case of NEC due to Rotavirus infection comparing clinical features, lab tests and development of Rotavirus-NEC to bacterial-NEC in order to identify the correct management and the best therapeutical strategy for this group of patients. Our case report described the complicated story of a preterm female affected by Rotavirus-NEC who underwent surgery three times, but at least with good outcome. Different risks factors predispose to NEC due to Rotavirus such as prematurity, seasonality and formula feeding. Associated symptoms are abdominal distention, tenderness, bloody stools and fever. Development of NEC in newborns affected by Rotavirus is pathognomonic: only a very small percentage of newborns affected by Rotavirus infections develop NEC, but all of them need surgery which is resolutive most of time. The average hospital stay of surgical newborns affected by Rotavirus infection was longer than that of newborns surgically treated for bacterial gastrointestinal infections. Prevention of Rotavirus infections may be important to decrease the incidence of NEC, the morbidity and the mortality rate in neonatal period.