Incidence Of NEC Research Articles

Human Breast Milk-Derived Extracellular Vesicles in the Protection Against Experimental Necrotizing Enterocolitis

PurposeNecrotizing enterocolitis (NEC) is a leading cause of death in premature infants. Breast feeding decreases the incidence of NEC but, even with aggressive promotion of nursing in Neonatal Intensive Care Units, morbidity and mortality remain high. Previous studies from our laboratory have demonstrated that extracellular vesicles (EVs) purified from mouse and rat stem cells can protect the intestines from NEC. The aim of this study was to determine whether human breast milk (BM)-derived EVs could prevent NEC. MethodsEVs were purified from human donor breast milk. NEC was induced in premature rat pups by exposure to asphyxia/hypothermia/hypercaloric feeds. Pups were randomized to: (1) breast fed, no injury, (2) NEC, (3) NEC + BM-derived EVs once intraperitoneally (IP), (4) NEC + BM-derived EVs enterally (PO) with each feed. Intestinal tracts were examined for histologic damage. Additionally, the effect of BM-derived EVs on intestinal epithelial cells (IEC) subjected to hypoxia/reoxygenation injury in vitro was examined. ResultsNEC incidence was 0% in breast-fed pups and 62% in pups subjected to NEC. IP administration of BM-derived EVs decreased NEC incidence to 29% and enteral administration further decreased NEC incidence to 11.9%. (p < 0.05). BM-derived EVs significantly increased cell proliferation and decreased apoptosis in IEC in vitro. ConclusionBreast milk-derived EVs delivered either IP or enterally significantly decrease the incidence and severity of experimental NEC, protect IEC from injury in vitro, and may represent an innovative therapeutic option for NEC in the future. Type of studyBasic science study. Level of evidenceN/A.

Incidence and Risk Factors of Necrotizing Enterocolitis Following Gastroschisis Repair in Correlation with Modes of Abdominal Wall Closure and Umbilical Management at Siriraj Hospital: an 11-Year Retrospective Review

Objective: We investigated the correlation between umbilical management and NEC in infants with gastroschisis as well as the incidence and potential risk factors of NEC in patients with gastroschisis at Siriraj Hospital from 2005 to 2016. Methods: A retrospective chart review was conducted of patients with gastroschisis who were surgically repaired at Siriraj Hospital from January 2005 to January 2016. The baseline characteristics, umbilical management, and short-term outcomes were analyzed in relation to NEC complications to determine the associated correlations and potential risk factors. Results: Overall, 106 patients were enrolled. The incidence of NEC following gastroschisis repair was 16% (17/106). Umbilical preservation was a significant potential risk factor for NEC (p = 0.009; hazard ratio = 5.14; 95% CI =1.51-17.42). There were no significant differences between the NEC and non-NEC group for gender, median Apgar scores, gestational ages, and birth weight. The short-term outcomes were significantly higher for the NEC than the non-NEC group, with a time to first oral feeding of 15 vs. 9 days (p = 0.006), duration of total parenteral nutrition, 22 vs. 12 days (p < 0.001), and length of stay, 32 vs. 23 days (p = 0.01) respectively. Conclusion: Umbilical preservation following gastroschisis repair was associated with a higher incidence of NEC, even in term infants. Thus, NEC should be carefully monitored after abdominal fascial closure with umbilical preservation.

Incidence and risk of necrotizing enterocolitis in Denmark from 1994-2014

Introduction. We suspected that the incidence of NEC in Denmark had increased during the last 20 years but hypothesized that this could be explained by the increased neonatal survival. Methods. We conducted a retrospective, observational cohort study of all registered liveborn infants in Denmark in the period from January 1, 1994 to December 31, 2014. Data were obtained from the Medical Birth Registry, National Patient Register, and Cause of Death register in Denmark. The primary outcome was the registration of NEC (ICD-10: DP77.9) during a hospital admission within 6 months after birth. The statistical analysis used ‘death before NEC’ as a competing risk. Results. The cohort consisted of 1,351,675 infants, of which 8,059 died. There was a strongly significant decreasing risk of death over the period for the all infants (p<0.0001 in all gestational age groups). In total, 994 infants were diagnosed with NEC which lead to an incidence of 7.4 per 10,000 live-born infants. During the observation period, the incidence increased from 6.3 to 7.9 per 10,000 births (p = 0.006). When accounting for ‘death before NEC’ as a competing risk, the increase could be explained by the increased neonatal survival. There was, however, a GA-group/epoch interaction (p = 0.008) in the cause-specific hazard ratios with a trend towards an increasing risk of NEC in the most preterm infants and a decreasing risk of NEC in the term infants. Conclusion. While the overall incidence of NEC increased over the study period, the overall risk of NEC did not increase when considering the increased survival. Nevertheless, there seemed to be an increased risk of NEC in the most premature infants which was masked by a decreased risk in the term infants. This study suggests that research to prevent NEC in the most preterm infants is more important now than ever.

1534. Prevalence and Outcome of Neutropenic Enterocolitis Among Pediatric Acute Myeloid Leukemia Patients: A Developing Country Experience

BackgroundNeutropenic enterocolitis (NEC) is a life-threatening disease with substantial morbidity and mortality, seen primarily in patients with hematologic malignancies. The frequency of NEC has increased with the widespread use of chemotherapeutic agents such as the taxanes, which cause severe gastrointestinal mucositis.MethodsThis was a retrospective study at the National Cancer Institute, Cairo University. The computerized records were screened for ultrasound or computerized tomographic scan requests for abdominal pain for all acute myeloid pediatrics inpatients (2012–2016). Retrospective case note analysis was used to collect clinical data for patients with features of Typhlitis. D 30 morbrtality was reported.ResultsThe incidence of NEC among our inpatients was 24% (49/203). Forty-three children had radiologically confirmed typhlitis, and six had clinical features alone. Most (93%) patients were profoundly neutropenic (ANC <100). All of the patients were subjected to conservative management. All of them needed ICU admission. Eighteen children had a variable period of bowel rest, including 12 patients who were supported with total parenteral nutrition. Three patients had laparotomy that revealed extensive colonic bowel necrosis (1), perforated bowel loop (1), and a perforated appendix (1).Two out of three cases of Laparotomy were diagnosed with Mucormycosis. 30-Days mortality was 44.8% (22/49).Relapsing typhlitis in subsequent courses was observed in 6/27 (22%) patients. Fulminant Gram-negative sepsis without surgical intervention was the leading cause of death in this cohort.ConclusionThe diagnosis of typhlitis was based on clinical features, supported by radiologic evidence in almost half of the study group. Surgical intervention should be reserved for specific complications or where another surgical pathologic condition cannot reasonably be ruled out. Though rare, fungal infection should be suspected specially in cases with worsening signs of typhlitis despite broad antimicrobial coverage.Disclosures All authors: No reported disclosures.

Time to Full Enteral Feeding for Very Low-Birth-Weight Infants Varies Markedly Among Hospitals Worldwide But May Not Be Associated With Incidence of Necrotizing Enterocolitis: The NEOMUNE-NeoNutriNet Cohort Study.

Transition to enteral feeding is difficult for very low-birth-weight (VLBW; ≤1500 g) infants, and optimal nutrition is important for clinical outcomes. Data on feeding practices and short-term clinical outcomes (growth, necrotizing enterocolitis [NEC], mortality) in VLBW infants were collected from 13 neonatal intensive care units (NICUs) in 5 continents (n = 2947). Specifically, 5 NICUs in Guangdong province in China (GD), mainly using formula feeding and slow feeding advancement (n = 1366), were compared with the remaining NICUs (non-GD, n = 1581, Oceania, Europe, United States, Taiwan, Africa) using mainly human milk with faster advancement rates. Across NICUs, large differences were observed for time to reach full enteral feeding (TFF; 8-33 days), weight gain (5.0-14.6 g/kg/day), ∆z-scores (-0.54 to -1.64), incidence of NEC (1%-13%), and mortality (1%-18%). Adjusted for gestational age, GD units had longer TFF (26 vs 11 days), lower weight gain (8.7 vs 10.9 g/kg/day), and more days on antibiotics (17 vs 11 days; all P < .001) than non-GD units, but NEC incidence and mortality were similar. Feeding practices for VLBW infants vary markedly around the world. Use of formula and long TFF in South China was associated with more use of antibiotics and slower weight gain, but apparently not with more NEC or higher mortality. Both infant- and hospital-related factors influence feeding practices for preterm infants. Multicenter, randomized controlled trials are required to identify the optimal feeding strategy during the first weeks of life.

METABOLIC THERAPY IN WOMEN WITH PLACENTARY DYSFUNCTION

The need for micronutrients during pregnancy increases by 25% due to increased consumption of the fetal organism. Omega-3 PUFAs are not synthesized in the human body and are indispensable, and are also part of the structural components of not only the brain lipids, but also the cells of the immune, cardiovascular systems and the visual analyzer. The use of Omega-3 PUFA promotes blood circulation in the mother-placenta-fetus system, improves the rheological properties of blood, prevents the development of preeclampsia and affects the reduction of perinatal complications. High efficiency, good tolerability, absence of teratogenic and embryotoxic actions allow wide use of Omega-3 PUFA in obstetric-gynecological practice.The aim of the study was a comparative analysis of the course of pregnancy, childbirth and the state of newborns in pregnant women with placental dysfunction who received metabolic therapy and those who did not receive it.Material and methods of the study. A prospective analysis of the course of pregnancy, childbirth and the state of newborns was conducted in 130 pregnant women with placental dysfunction (PD) at the gestation period of 28-34 weeks, which gave birth in Odessa Regional Perinatal Center of the Regional Clinical Hospital. Patients were divided into 2 groups: I – the main group (MG) (n = 67) – pregnant women with PD who received metabolic therapy in the form of 300 mg of Omega-3 PUFA per day for 4 weeks, II – control group (CG) ( n = 63) – pregnant women with PD who did not receive metabolic therapy. In the examined patients of MG, it was found that, according to the Doppler study of FPC, pregnancy was complicated by violations of the fetus-placental blood flow of the II st. in 36 (53,7%) and III st. – 8 (12,0%). And in pregnant women of CG is significantly more likely – 45 (71,4%) and 14 (22,2%), respectively. Such complications of newborns as RDS – 31 (49,2%), IVH – 33 (52,4%), HIE – 49 (77,8%), NEC – 34 (54,0%) were more often expressed in women of CG.Conclusions. The use of Omega-3 PUFA improves perinatal outcomes, reduces the incidence of IVH 17 (25,4%), reduces the frequency of HIE 27 (40,3%), reduces the incidence of NEC 16 (23,9%), and reduces the the risk of developing RDS in premature infants 22 ( 32,8%). Newborns of MG pregnant had higher scores on the Apgar scale (1st. min. – 6,66 ± 1,0, and 5 th. -7,26 ± 0,81 point) compared to the newborns of women of the CG (1st. min. – 5,65 ± 1,54 p., the 5 th. – 6,38 ± 1,68 p.). The average weight of children at birth was greater in the MG (1608 ± 292 g, in the CG-1470 ± 304 g.).

Potential role of stem cells in disease prevention based on a murine model of experimental necrotizing enterocolitis

BackgroundNecrotizing enterocolitis (NEC) is a devastating disease of newborns, and despite years of research, there is no known cure. The mortality rate of infants with NEC remains as high as 20%–30%. Babies who survive NEC frequently have long term complications including short gut syndrome, developmental delays and neurological sequelae. Unfortunately, despite much research over the past years, the precise pathogenesis of the disease is still not completely understood. MethodsOur laboratory has focused on identifying novel therapies to prevent the disease, including the use of stem cells (SC), heparin-binding epidermal growth factor-like growth factor (HB-EGF) and recently, stem cell derived-exosomes, a type of nanovesicle, to combat this illness. ResultsWe have outlined the major SC lines and data suggesting potential benefit as a curative or preventive approach for NEC as well as describing several new therapeutic strategies, including stem cell derived- exosomes and HB-EGF for decreasing the incidence and severity of this disease in rat models in our lab. ConclusionOverall, our lab has demonstrated that these different types of SC equivalently reduce the incidence and severity of NEC and equally preserve intestinal barrier function during NEC. We have previously demonstrated that AF-MSC can protect the intestines from intestinal injury and may therefore hold strong therapeutic potential for the prevention of NEC. Most recently, our work with stem cell derived-exosomes has shown them to be equivalent to their derived SC lines in decreasing the incidence of this disease.

The influences of the establishment of breast milk bank to the premature infants in the hospital

Objective To discuss the influences of the establishment of breast milk bank to the premature infants in the hospital. Methods The clinical datas of 239 premature infants admitted in NICU from Feb 2017 to Jan 2018 were retrospectively analyzed. Dividing them into two groups, one was control group that the premature infants born before the establishment of breast milk bank, the other was observation group that the premature infants born after that. Both groups were taken the same treatment; and fed the autogenous breast milk or donated breast milk or premature milk based on the intention of infant′s family. Results In observation group,the breastfeeding rate was 67.5% (85/126),the average hospital-stay time was (24.5±4.4) days.But in control group, the breastfeeding rate was 34.5% (39/113),the average hospital-stay time was (36.3±8.3) days, there were significant differences between the two groups(χ2=4.217, t=2.941, P<0.05) .The complications in observation group included necrotizing enterocolitis (5 cases),bronchopulmonary dysplasia(3 cases), retinopathy of prematurity (5 cases) and sepsis (6 cases), the incidence of which was lower than that in control group. But, there was statistical significance in the incidence of necrotizing enterocolitis and sepsis only (χ2=3.989, 5.386, P<0.05). Conclusions The establishment of breast milk bank can help to improve the breastfeeding rate of premature infants,shorten the hospital-stay time,reduce the incidence of NEC and sepsis,make premature infants recover more quickly. Key words: Intensive care units; Infant, premature; Breast milk bank; Breast feeding

Impact of umbilical cord milking and pasteurized donor human milk on necrotizing enterocolitis: a retrospective review

BackgroundNecrotizing enterocolitis (NEC) is a serious complication of prematurity. Our objective was to evaluate the impact of an umbilical cord milking protocol (UCM) and pasteurized donor human milk (PDHM) on NEC rates in infants less than 30 weeks gestational age from January 1, 2010 to September 30, 2016. We hypothesized an incremental decrease in NEC after each intervention.MethodsWe performed a retrospective review of 638 infants born less than 30 weeks gestational age. Infants were grouped into three epochs: pre-UCM/pre-PDHM (Epoch 1, n = 159), post-UCM/pre-PDHM (Epoch 2, n = 133), and post-UCM/post-PDHM (Epoch 3, n = 252). The incidence of NEC, surgical NEC, and NEC/death were compared. Logistic regression was used to determine independent significance of time epoch, gestational age, birth weight, and patent ductus arteriosus for NEC, surgical NEC, and death/NEC.ResultsAt birth, infants in Epoch 1 were younger than Epoch 2 and 3 (26.8 weeks versus 27.3 and 27.2, respectively, P = 0.036) and smaller (910 g versus 1012 and 983, respectively, P = 0.012). Across epochs, there was a significant correlation between patent ductus arteriosus treatment and NEC rate (P < 0.001, Cochran-Mantel-Haenszel). There was a significant decrease in rates of NEC, surgical NEC, and NEC/death between groups. Logistic regression showed this as significant for rates of NEC and surgical NEC between Epoch 1 and 3. Patent ductus arteriosus was a significant variable affecting the incidence of NEC, but not surgical NEC or death/NEC.ConclusionsAn umbilical cord milking protocol and pasteurized donor human milk availability was associated with decreased rates of NEC and surgical NEC. This suggests an additive effect of these interventions in preventing NEC.

Treatment of experimental necrotizing enterocolitis with stem cell-derived exosomes

PurposeNecrotizing enterocolitis (NEC) remains a devastating disease in premature infants. We previously showed that four stem cell (SC) types equivalently improve experimental NEC. Exosomes are intercellular nanovesicles containing RNA, miRNA, DNA, and protein. Because SC therapy faces challenges, our aim was to determine if the beneficial effects of SC are achievable with cell-free exosomes. MethodsExosomes from four SC types were compared: (1) amniotic fluid-derived mesenchymal SC (AF-MSC); (2) bone marrow-derived MSC (BM-MSC); (3) amniotic fluid-derived neural SC (AF-NSC); and (4) neonatal enteric NSC (E-NSC). Rat pups exposed to NEC received a varying concentration of a single type of exosome with control pups receiving PBS only. Intestinal damage was graded histologically. ResultsThe incidence of NEC was 0% in unstressed pups and 60.7% in control pups subjected to NEC. Exosomes (4.0×108) reduced NEC incidence to: AF-MSC 25.0%; BM-MSC 23.1%; AF-NSC 11.1%; E-NSC 27.3%. When administered at a concentration of at least 4.0×108, all groups demonstrated a significant reduction in NEC compared to untreated pups. At this minimum concentration, there was no difference in treatment efficacy between exosomes and the SC from which they were derived. ConclusionStem cell-derived exosomes reduce the incidence and severity of experimental NEC as effectively as the stem cells from which they are derived, supporting the potential for novel cell-free exosome therapy for NEC. Type of studyBasic science.

Standardized feeding and probiotic supplementation for reducing necrotizing enterocolitis in preterm infants in a resource limited set up.

Necrotizing enterocolitis (NEC ≥ Stage II) is associated with high mortality and morbidity in preterm infants. To assess if introduction of standardized feeding regimen (SFR) and routine probiotic supplementation (RPS) was associated with reduced incidence of NEC in preterm infants in our nursery in a resource limited set up. This was a retrospective cohort study assessing the incidence of NEC ≥ Stage II before (Epoch 1: N = 144) vs. after (Epoch 2, N = 144) implementation of SFR and RPS in preterm infants < 35 weeks. The median (IQR) gestation and birth weight in epoch 1 and epoch 2 was [32 (30, 33.5) vs. 31.5 (30, 34) weeks, p = 0.829], and [1350 (1100, 1700) vs. 1370 (1110, 1550) g, p = 0.363] respectively. Both groups had predominantly outborn infants (Epoch 1: 79.2% vs. Epoch 2: 78.2%; p = 1.00). Multivariate analysis after adjusting for potential confounders found a significantly lower incidence of NEC ≥ Stage II after implementing SFR and RPS (Epoch 1: 17.4% vs. Epoch 2:9.0%, adjusted odds ratio aOR: 0.19; 95% CI: 0.05, 0.71, p = 0.013). The incidence of the composite outcome of 'NEC or Mortality' was also significantly lower after the intervention (Epoch 1: 21.5% vs. Epoch 2: 14.6%; aOR 0.24, 95% CI: 0.07, 0.85, p = 0.027). Introduction of SFR and RPS was associated with significant reduction in NEC ≥ Stage II and the composite outcome of NEC ≥ Stage II /mortality in preterm infants.

The initial prophylactic antibiotic usage and subsequent necrotizing enterocolitis in high-risk premature infants: a systematic review and meta-analysis.

To investigate the correlation between the initial prophylactic antibiotic use and the subsequent NEC in high-risk premature infants. We performed a literature search of PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Web of Science, and nine studies with a total of 5207 infants were selected for inclusion in this study. The pooled estimate for the seven studies combined indicating that prophylactic antibiotic usage was associated with a non-significant trend toward increased incidence of NEC [odds ratio (OR) 0.75; 95% confidence interval (CI) 0.26-2.17], and prolonged exposure to prophylactic antibiotics, compared with limited prophylactic antibiotic use, was associated with a significant trend toward the risk of increasing incidence of NEC (OR 1.31; 95% CI 1.08-1.59). Current evidence does not support the use of prophylactic antibiotics to reduce the incidence of NEC for high-risk premature infants.

Highly Concentrated Preterm Formula as an Alternative to Powdered Human Milk Fortifier: A Randomized Controlled Trial.

The aim of the study was to assess clinical feasibility and tolerance of concentrated preterm formula at 30 kcal/oz (CPF30) to fortify human milk to a caloric density of 24 kcal/oz, compared to conventional powdered human milk fortifier (PHMF). Very low birth weight neonates were stratified by birth weight and randomized to receive human milk fortification using CPF30 or PHMF. Infants were monitored from first introduction of human milk fortification, until fortified feeds were well tolerated. Primary outcome was weight gain; secondary outcomes included other measures of feeding intolerance (residual gastric aspirates, feeds held, prokinetic therapy), sepsis, and death. The clinical and study personnel were blinded to the intervention. No significant differences in weight gain or other measures of feeding tolerance were demonstrated between CPF30 and PHMF. Macronutrient intake was similar between both groups. Infants with a birth weight of ≥ 1000 g who received CPF30, experienced fewer days NPO (nil per os; nothing per mouth) and a trend toward lower incidence of NEC, compared with those who received PHMF.. The amount of human milk consumed was significantly lower in the CPF30 group. Both fortifiers were similarly well tolerated. Fortification of human milk with CPF30 is a safe and feasible alternative to conventional PHMF.

Dimethyloxalylglycine preserves the intestinal microvasculature and protects against intestinal injury in a neonatal mouse NEC model: role of VEGF signaling.

BackgroundNEC is a devastating neonatal disease characterized by intestinal necrosis. Hypoxia inducible factor-1α (HIF-1α) plays a critical role in cellular oxygen homeostasis. Here, we hypothesized that prolyl hydroxylase (PHD) inhibition, which stabilizes HIF-1α, protects against NEC by promoting intestinal endothelial cell proliferation and improving intestinal microvascular integrity via VEGF signaling.MethodsTo assess the role of PHD inhibition in a neonatal mouse NEC model, we administered DMOG or vehicle to pups prior to or during the NEC protocol, and determined mortality and incidence of severe intestinal injury. We assessed intestinal VEGF by Western blot and quantified endothelial cell and epithelial cell proliferation following immunofluorescence.ResultsDMOG decreased mortality and incidence of severe NEC, increased intestinal VEGF expression, and increased intestinal villus endothelial and epithelial cell proliferation in experimental NEC. Inhibiting VEGFR2 signaling eliminated DMOG’s protective effect on intestinal injury severity, survival, and endothelial cell proliferation while sparing DMOG’s protective effect on intestinal epithelial cell proliferation.ConclusionDMOG upregulates intestinal VEGF, promotes endothelial cell proliferation and protects against intestinal injury and mortality in experimental NEC in a VEGFR2-dependent manner. DMOG’s protective effect on the neonatal intestinal mucosa may be mediated via VEGFR-2 dependent improvement of the intestinal microvasculature.

To study the role of probiotics in the prevention of necrotizing enterocolitis in preterm neonates

Background: Necrotizing enterocolitis is defined as an inflammatory bowel necrosis in premature infants and is major cause of morbidity and mortality in neonatal intensive care units throughout the world. We aim to study the role of probiotics in reducing incidence and severity of necrotizing enterocolitis in preterm neonates ≤34 weeks and its role on secondary outcomes like mortality, time to reach full feeds, daily weight gain, days of hospitalization and effect on nosocomial infections.Methods: This study was a prospective randomized controlled interventional trial conducted in SGRDIMSAR, Amritsar. A sample size of 150 was selected. 75 were randomized to test group and 75 to control group by simple random sampling.Results: The incidence of NEC was significantly lower in the test group compared with the control group (1 of 75 neonates vs 12 of 75 neonates; p=0.001). The severity of NEC, nosocomial sepsis and mean duration of hospital stay was significantly lower in the test group. Daily weight gain was significantly higher in the test group. There was no significant difference in mean age of onset of NEC, mortality and mean age to reach full feeds in two groups.Conclusions: Incidence and severity of NEC was less in the probiotic group. Daily weight gain was better, nosocomial sepsis and mean duration of hospital stay were less in the probiotic group.

A study on preterm births during 2013–2015, Shiraz, Iran

Preterm birth is the leading cause of neonatal and infant mortality and a substantial portion of neonatal morbidities. The perinatal mortality and morbidity statistics in developing countries are inadequate. In this study, we assessed prevalence and health outcomes of preterm deliveries in tertiary care university hospitals. A retrospective study of hospital records of premature babies born in all the five governmental tertiary care settings during the time interval of 2013–2015 in Shiraz was conducted. Result of this study showed that there was an overall 127.6 premature births per 1000 live births in the study duration. 23.8% of premature newborn had RDS and Incidence of prematurity with RDS was 82.4 per thousand live births. 52.6% of premature newborns were hospitalised in NICU and 8.5% had ROP. Five percent suffered from sepsis and 1% suffered from NEC. Overall mortality was nearly 10% of all the premature newborn. In conclusion, this study showed that premature births and its complications for newborn need to be addressed more in Iran.Impact statementPreterm birth is the leading cause of neonatal mortality and morbidities. Mortality and morbidity statistics related to preterm infants are important healthcare indicators implying the quality of the perinatal health care system and are prerequisite for the identification of problems and implementation of preventive measures. However, the perinatal mortality and morbidity statistics in developing countries are inadequate.The aim of this study was to assess prevalence and health outcome of preterm deliveries in tertiary care university hospitals in Shiraz city, Iran.This study showed that prematurity rate was 12.7%. Among preterm cases, 52.6% were admitted to NICU. RDS occurred among 23.8% of the total premature neonates and 8.2% of the total live births. The incidence of NEC was 1/0% of the total premature neonates and 0.4% of the total live births. The incidence of sepsis was 5% of the premature neonates and 1.9% of the total live births and the incidence of ROP was 8.5% among the premature neonate. The overall mortality of premature neonates was 9.9% of the total premature neonates and 1.2% of the total live births.Rigorous measures for prevention of premature births and its complications for newborns are required in Iran.

Probiotics for the prevention of necrotising enterocolitis in very low-birth-weight infants: a meta-analysis and systematic review.

Overall, probiotics lead to significant reductions in NEC incidence and mortality in VLBW infants. Differences in probiotic agents and the influence of prenatal steroids and feeding regimens may explain the differences in outcomes between studies.

Human milk oligosaccharide composition predicts risk of necrotising enterocolitis in preterm infants

ObjectiveNecrotising enterocolitis (NEC) is one of the most common and often fatal intestinal disorders in preterm infants. Markers to identify at-risk infants as well as therapies to prevent and treat...

Evaluating the efficacy of different types of stem cells in preserving gut barrier function in necrotizing enterocolitis

BackgroundNecrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality in premature infants. Increased intestinal permeability is central to NEC development. We have shown that stem cells (SCs) can reduce the incidence and severity of NEC. Our current goal was to investigate the efficacy of four different types of SC in preservation of gut barrier function during NEC. Materials and methodsWe compared (1) amniotic fluid–derived mesenchymal SC, (2) bone marrow–derived mesenchymal SC, (3) amniotic fluid–derived neural SC, and (4) enteric neural SC. Premature rat pups received an intraperitoneal injection of 2 × 106 SC or phosphate-buffered saline only and were then subjected to experimental NEC. Control pups were breastfed and not subjected to NEC. After 48 h, animals received a single enteral dose of fluorescein isothiocyanate -labeled dextran (FD70), were sacrificed 4 h later, and serum FD70 concentrations determined. ResultsCompared to breastfed, unstressed pups with intact gut barrier function and normal intestinal permeability (serum FD70 concentration 2.22 ± 0.271 μg/mL), untreated pups exposed to NEC had impaired barrier function with significantly increased permeability (18.6 ± 4.25 μg/mL, P = 0.047). Pups exposed to NEC but treated with SC had significantly reduced intestinal permeability: Amniotic fluid–derived mesenchymal SC (9.45 ± 1.36 μg/mL, P = 0.017), bone marrow–derived mesenchymal SC (6.73 ± 2.74 μg/mL, P = 0.049), amniotic fluid–derived neural SC (8.052 ± 1.31 μg/mL, P = 0.0496), and enteric neural SC (6.60 ± 1.46 μg/mL, P = 0.033). ConclusionsSCs improve gut barrier function in experimental NEC. Although all four types of SC reduce permeability equivalently, SC derived from amniotic fluid may be preferable due to availability at delivery and ease of culture, potentially enhancing clinical translation.

Stem cells and necrotizing enterocolitis: A direct comparison of the efficacy of multiple types of stem cells

PurposeNecrotizing enterocolitis (NEC) is a leading cause of gastrointestinal morbidity and mortality in premature infants. While studies have shown potential for stem cell (SC) therapy in experimental NEC, no study has compared different SC side-by-side. Our purpose was to determine whether one type of SC may more effectively treat NEC than others. MethodsFour SC were compared: (1) amniotic fluid-derived mesenchymal SC (AF-MSC); (2) amniotic fluid-derived neural SC (AF-NSC); (3) bone marrow-derived mesenchymal SC (BM-MSC); and (4) neonatal enteric neural SC (E-NSC). Using an established rat model of NEC, pups delivered prematurely received an intraperitoneal injection of SC. Control pups were injected with PBS. Additional controls were breast-fed by surrogates and not subjected to experimental NEC. Intestinal tissue was graded histologically. ResultsNEC incidence was: PBS, 61.3%; breast-fed unstressed, 0%; AF-MSC, 19.1%; BM-MSC, 22.9%; AF-NSC, 18.9%; E-NSC 22.2%. All groups demonstrated statistical significance (p<0.05) compared to controls, and there was no difference between SC groups. ConclusionAll four SC groups reduced the incidence and severity of experimental NEC equivalently. AF-MSC may be preferable because of availability of AF at delivery and ease of expansion, increasing potential for clinical translation. Level of EvidenceV (Animal study).