Necrotizing Enterocolitis In Preterm Infants Research Articles

Trends and risk factors analysis of NEC in preterm infants over 9 years

BackgroundInvestigating the trend of changes in the occurrence of necrotizing enterocolitis (NEC) in preterm infants during 9 years and analyzing the risk factors of NEC with the purpose of providing reference for clinical diagnosis and treatment of NEC.MethodsClinical data of NEC in preterm infants with Bell’s stage ≥ II from January 2013 to December 2021 in the Neonatology Department of the Third Affiliated Hospital of Zunyi Medical University was retrospectively analyzed. Trends in the occurrence of NEC in preterm infants were analyzed by the trend chi-square test. Subsequently, the general data (sex, gestational age, singleton or multiple births, birth weight, serum albumin, alkaline phosphatase, sepsis, blood transfusion, mechanical ventilation, RDS, arterial catheterization) and perinatal data (intrauterine distress, turbid amniotic fluid, premature rupture of membranes, mode of delivery, fetal heart abnormalities, diabetes mellitus) were collected; then, the risk factors for NEC were analyzed by univariate and multivariate logistic-regression analysis.ResultsIn the past 9 years, 77 cases of NEC occurred, with the incidence rate of 1.95%, and the incidence of NEC in preterm infants has been increasing year by year (P < 0.05). The results of univariate analysis showed that the morbidity of NEC in preterm infants was associated with premature rupture of membranes, blood transfusion, sepsis, and the of serum albumin (P < 0.05). Multivariate logistic regression analysis revealed that blood transfusion (OR = 2.232, 95% CI: 1.012–4.923) and sepsis (OR = 0.899, 95% CI: 0.809–3.915) were independent risk factors of NEC in preterm infants, while high serum albumin (OR = 0.899, 95% CI: 0.809–3.915) was an independent protective factor of NEC in preterm infants.ConclusionThe morbidity of NEC is gradually increasing. Inhibition of infection and limitation of blood transfusion are effective measures to reduce the occurrence of NEC. Meanwhile, high serum albumin is a protective factor for NEC.

Is choline deficiency an unrecognized factor in necrotizing enterocolitis of preterm infants?

We undertook this review to determine if it is plausible that choline or phosphatidylcholine (PC) deficiency is a factor in necrotizing enterocolitis (NEC) after two clinical trials found a dramatic and unexpected reduction in NEC in an experimental group provided higher PC compared to a control group. Sources and amounts of choline/PC for preterm infants are compared to the choline status of preterm infants at birth and following conventional nutritional management. The roles of choline/PC in intestinal structure, mucus, mesenteric blood flow, and the cholinergic anti-inflammatory system are summarized. Low choline/PC status is linked to prematurity/immaturity, parenteral and enteral feeding, microbial dysbiosis and hypoxia/ischemia, factors long associated with the risk of developing NEC. We conclude that low choline status exists in preterm infants provided conventional parenteral and enteral nutritional management, and that it is plausible low choline/PC status adversely affects intestinal function to set up the vicious cycle of inflammation, loss of intestinal barrier function and worsening tissue hypoxia that occurs with NEC. In conclusion, this review supports the need for randomized clinical trials to test the hypothesis that additional choline or PC provided parenterally or enterally can reduce the incidence of NEC in preterm infants. IMPACT STATEMENT: Low choline status in preterm infants who are managed by conventional nutrition is plausibly linked to the risk of developing necrotizing enterocolitis.

Biomarkers in the Severity of Necrotizing Enterocolitis in Preterm Infants: A Pilot Study.

The occurrence of necrotizing enterocolitis (NEC) is a common and severe disease of the digestive system in neonates. This study aims to assess the value of the intestinal tissue oxygen saturation (rintSO2) combined with the levels of procalcitonin (PCT) and mean platelet volume (MPV) in predicting the severity of NEC in preterm infants. This experiment was a retrospective cohort study conducted in the Department of Pediatrics, Hongqi Hospital Affiliated to Mudanjiang Medical University between January 2017 and July 2022. Premature neonates with NEC were enrolled and divided into mild-moderate NEC group and severe NEC group according to Bell's stage. The general information data, rintSO2 and blood parameters such as the white blood cell (WBC) count, platelet count (PLT), PCT, MPV, red blood cell distribution width (RDW), hemoglobin (Hb), C-reactive protein (CRP) were compared between the two groups. A total of 122 patients were enrolled, including 79 mild-moderate NEC and 43 severe NEC. The rintSO2 was lower in severe group than in mild-moderate group (P = 0.042), the PCT and MPV were both higher in severe group than in mild-moderate group (P = 0.048, P = 0.049). The results of logistic regression suggested that the rintSO2 (OR = 1.491, P = 0.003), PCT (OR = 3.071, P = 0.001) and MPV (OR = 4.027, P = 0.015) were independent predictive factors for severity of NEC. The area under the curve (AUC) of the rintSO2 combined with PCT and MPV showed good diagnostic ability in the severity of NEC. The rintSO2 combined with PCT and MPV may be considered as the early biomarkers in the severity of NEC and could help us to diagnose the case early with early treatment with better prognosis.

Predictive value of hemoglobin decrease for necrotizing enterocolitis in preterm infants with late-onset sepsis

To study the predictive value of hemoglobin (Hb) decrease for the occurrence of necrotizing enterocolitis (NEC) in preterm infants with late-onset sepsis (LOS) . Clinical data of 93 LOS preterm infants were collected for retrospective analysis, among which 16 infants developed NEC while 77 infants did not. Based on the decrease in Hb levels from the most recent Hb measurement before LOS occurrence to the initial Hb levels during LOS, the infants were divided into three groups: no Hb decrease (n=15), mild Hb decrease (Hb decrease <15 g/L; n=35), and severe Hb decrease (Hb decrease ≥15 g/L; n=43). Multivariate logistic regression analysis was conducted to explore the predictive factors for NEC secondary to LOS, and the value of Hb decrease in predicting NEC secondary to LOS was evaluated through receiver operating characteristic curve analysis. The incidence of NEC in the severe Hb decrease group, mild Hb decrease group, and no Hb decrease group were 26%, 14%, and 0% (P<0.05), respectively. Multivariate logistic regression analysis revealed that a larger Hb decrease was an independent predictive factor for NEC in LOS preterm infants (OR=1.141, 95%CI: 1.061-1.277, P<0.001). Receiver operating characteristic curve analysis showed that the area under the curve for predicting NEC in preterm infants with LOS using Hb decrease (with a cut-off value of 20 g/L) was 0.803, with sensitivity and specificity of 0.69 and 0.78, respectively. Hb decrease can serve as an indicator for prediction of NEC in preterm infants with LOS.

Impact of fetal inflammatory response on the severity of necrotizing enterocolitis in preterm infants.

Neonates born with fetal inflammatory response (FIR) are at increased risk for adverse neonatal outcomes. Our objective was to determine whether FIR and its severity is associated with severity of necrotizing enterocolitis (NEC) in preterm infants. A case-control retrospective study of infants <33 weeks gestational age or <1500 g birthweight, including 260 with stage I-III NEC and 520 controls matched for gestational age. Placental pathology was evaluated, and FIR progression and its severity were defined according to Amsterdam classification. In this study, mild FIR (i.e., stage 1 FIR) was present in 52 controls (10.0%) and 22 infants with stage I-III NEC (8.5%), while moderate to severe FIR (i.e., ≥stage 2 FIR) was present in 16 controls (3.1%) and 47 infants with stage I-III NEC (18.1%). Both stage and grade of FIR were associated with stage of NEC (P < 0.001). On multinomial logistic regression, stage III NEC was associated with stage of FIR (P < 0.001). This is the first report demonstrating the association between progression and increasing severity of FIR and stage of NEC. Fetal Inflammatory Response (FIR) and its progression and severity are associated with the stages of necrotizing enterocolitis (NEC). This is the first study demonstrating the impact of progression and severity of FIR on stage III NEC. These observations provide additional insight into understanding the impact of intrauterine exposure to inflammation on the severity of NEC in preterm infants.

Identification of omega-3 oxylipins in human milk-derived extracellular vesicles with pro-resolutive actions in gastrointestinal inflammation.

Premature infants (PIs) are at risk of suffering necrotizing enterocolitis (NEC), and infants consuming human milk (HM) show a lower incidence than infants receiving formula. The composition of HM has been studied in depth, but the lipid content of HM-derived small extracellular vesicles (HM sEVs) remains unexplored. Identifying these molecules and their biological effects has potential for the treatment of intestinal disorders in PIs and could contribute to the development of HM-based fortified formulas. We isolated HM sEVs from HM samples and analyzed their oxylipin content using liquid chromatography coupled to mass spectrometry, which revealed the presence of anti-inflammatory oxylipins. We then examined the efficacy of a mixture of these oxylipins in combating inflammation and fibrosis, in vitro and in a murine model of inflammatory bowel disease (IBD). HM-related sEVs contained higher concentrations of oxylipins derived from docosahexaenoic acid, an omega-3 fatty acid. Three anti-inflammatory oxylipins, 14-HDHA, 17-HDHA, and 19,20-DiHDPA (ω3 OXLP), demonstrated similar efficacy to HM sEVs in preventing cell injury, inducing re-epithelialization, mitigating fibrosis, and modulating immune responses. Both ω3 OXLP and HM sEVs effectively reduced inflammation in IBD-model mice, preventing colon shortening, infiltration of inflammatory cells and tissue fibrosis. Incorporating this unique cocktail of oxylipins into fortified milk formulas might reduce the risk of NEC in PIs and also provide immunological and neurodevelopmental support.

Novel scoring system for early diagnosis of necrotizing enterocolitis: integrating clinical and laboratory data with urinary caveolin-1 levels.

Necrotizing enterocolitis (NEC) poses a significant threat to preterm infants, with nonspecific early manifestations complicating timely diagnosis. Therefore, this study aimed to develop a novel scoring system for early diagnosis of NEC, incorporating clinical and laboratory data with urinary caveolin-1 levels. A single-center prospective cohort study was conducted at a tertiary hospital in East Java, Indonesia. NEC diagnosis was established by Bell's criteria and proven gut dysbiosis. Urinary levels of claudin-2, caveolin-1, and epidermal growth factor (EGF) were assessed as potential indicators of tight junction disruption. The selected urine biomarker cutoff value was determined using symbolic classification analysis and combined with clinical and laboratory parameters from Bell's criteria to create an NEC scoring system, validated with the Aiken index. Sensitivity and specificity analyses were performed. Thirty-four neonates, comprising NEC, preterm non-NEC, and term infants, were included. qPCR analysis highlighted elevated Klebsiella, Lactobacillus, Clostridium, and Bacteroides levels in NEC patients, indicating a gut dysbiosis trend. Among 3 biomarkers, caveolin-1 ≥ 17.81 ng/dl on day 3 demonstrated 72.86% negative predictive value and 87.50% positive predictive value. The combined scoring system which comprised abdominal cellulitis, distension, radiology, advanced resuscitation at birth, prematurity or low birthweight, platelet count, sepsis, orogastric retention, metabolic acidosis and caveolin-1 findings exhibited an AUC of 0.922 (95% CI: 0.81-1.00, p < 0.001), with ≥ 1.81 as the cutoff, offering 93% sensitivity and 94% specificity. Urine caveolin-1 on day 3 signifies enterocyte tight junction damage and the acute phase of NEC in premature infants. The proposed scoring system demonstrates good performance in predicting NEC incidence in preterm infants.

The Association of Human Milk Proportion with the Clinical Outcomes of Necrotizing Enterocolitis in Preterm Infants: A Retrospective Study.

Human milk (HM) has been associated with a lower risk of necrotizing enterocolitis (NEC). However, the association of precise HM proportion with the outcome of NEC remains unclear. A total of 77 cases and 154 matched controls were included in this study. The samples were divided into three groups based on the HM proportion of the total enteral intake before NEC onset: ≥70% (HHM), <70% (LHM), and 0% (NHM). The study cohort did not show a significant association between different HM proportions and NEC risk. The adjusted odds ratio (OR) for the highest versus the lowest intake was 0.599. In the prognosis of NEC, different HM proportions significantly affected weight gain, the timing of NEC onset, diagnosis time, hospitalization cost, and the severity of NEC (p < 0.05). Our findings support the beneficial effects of HM on reducing NEC in preterm infants, particularly when a greater proportion of HM of the total enteral intake is included in their feeding. Additionally, the study indicates that preterm infants fed with lower proportions of HM of the total enteral feeding are more prone to experiencing severe cases of NEC.

Is The Use Of Probiotics In Premature Newborns Preventive For TheDevelopment Of Necrotizing Enterocolitis?Study Carried Out In The Neonatal Units Of Epic Latino, 2015 – 2020 Period

This retrospective cross-sectional study investigated the relationship between probiotic use and necrotizing enterocolitis (NEC) prevention in premature newborns at the Neonatal Units of Epic Latino between 2015 and 2020. The study included 8,632 premature newborns, 309 of whom developed enterocolitis. Results showed that gestational age was the primary risk factor for NEC development, with incidence inversely proportional to gestational age. Probiotic administration was not found to be a significant protective factor against NEC. The study suggests that further research on probiotic type, dosage, and administration is required to determine their effectiveness in preventing NEC in premature infants

Comparison of the frequency of necrotizing enterocolitis in preterm infants with formula feed versus breast feed.

Objective: To find out the frequency of necrotizing enterocolitis (NEC) in preterm infants and to compare the frequency of NEC in preterm infants with formula feed versus breast feed. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, Ghazi Khan Medical College, Dera Ghazi Khan, Pakistan. Period: January 2022 to June 2022. Material &amp; Methods: A total of 174 preterm infants were enrolled. The NEC was diagnosed as abdominal distention or intolerance to nasogastric feed with pneumatosis intestinalis / portal venous gas or free intraperitoneal air which was confirmed by abdomen X-ray. At the time of enrollment, gestational age and weight were recorded. All preterm neonates were called for follow up every week for 4 weeks to diagnose NEC. Results: Of these 174 study cases, 101 (58.0 %) were male patients while 73 (42.0 %) were female patients. Mean gestational age of our study cases was 30.48 ± 3.24 weeks. Of these 174 study cases, 102 (58.6%) mothers were illiterate. Breastfeeding was noted in 74 (42.5%) infants while formula feeding was recorded among 100 (57.5%) infants. The NEC was reported among 61 (35.1%) cases whereas NEC in breastfeeding cases was found in 14 (18.9%) and 47 (47.0%) infants with formula feeding. Conclusion: High frequency of NEC was observed among preterm infants given formula feeding in comparison to breastfed preterm infants. Significant linkage of NEC was noted with gender, maternal literacy, birth weight and pattern of feeding.

Pathogenesis of Necrotizing Enterocolitis in Preterm Infants: An Adaptation of Neuman's Systems Theory.

Preterm infants have increased morbidity and mortality due to immature physiology and neonatal complications. Necrotizing enterocolitis (NEC) is a devastating gastrointestinal complication that affects morbidity and mortality in preterm infants. The authors present an adaptation of Neuman's systems model called the NEC systems model to explore intrinsic and extrinsic factors leading to NEC in preterm infants. The literature was searched for theoretical models to guide exploration of neonatal disease influenced by the environment. Neuman's Systems Model provides a holistic approach to care of the system, offering a foundation to develop frameworks to examine preterm infants in their environment with associated stressors.

Early antibiotics and risk for necrotizing enterocolitis in premature infants: A narrative review.

While prompt initiation of antibiotics at birth due to concerns for early onset sepsis is common, it often leads to many preterm infants being exposed to treatment despite negative blood cultures. Such exposure to early antibiotics can impact the developing gut microbiome putting infants at increased risk of several diseases. Necrotizing enterocolitis (NEC), a devastating inflammatory bowel disease that affects preterm infants, is among the most widely studied neonatal disease that has been linked to early antibiotics. While some studies have demonstrated an increased risk of NEC, other studies have demonstrated seemingly contrary findings of decreased NEC with early antibiotics. Studies using animal models have also yielded differing findings of benefit vs. harm of early antibiotic exposure on subsequent NEC susceptibility. We thus sought to conduct this narrative review to help clarify the relationship between early antibiotics exposure and future risk of NEC in preterm infants. Our objectives are to: (1) summarize findings from human and animal studies that investigated the relationship between early antibiotics and NEC, (2) highlight important limitations of these studies, (3) explore potential mechanisms that can explain why early antibiotics may increase or decrease NEC risk, and (4) identify future directions for research.

Necrotizing Enterocolitis: The Role of Hypoxia, Gut Microbiome, and Microbial Metabolites.

Necrotizing enterocolitis (NEC) is a life-threatening disease that predominantly affects very low birth weight preterm infants. Development of NEC in preterm infants is accompanied by high mortality. Surgical treatment of NEC can be complicated by short bowel syndrome, intestinal failure, parenteral nutrition-associated liver disease, and neurodevelopmental delay. Issues surrounding pathogenesis, prevention, and treatment of NEC remain unclear. This review summarizes data on prenatal risk factors for NEC, the role of pre-eclampsia, and intrauterine growth retardation in the pathogenesis of NEC. The role of hypoxia in NEC is discussed. Recent data on the role of the intestinal microbiome in the development of NEC, and features of the metabolome that can serve as potential biomarkers, are presented. The Pseudomonadota phylum is known to be associated with NEC in preterm neonates, and the role of other bacteria and their metabolites in NEC pathogenesis is also discussed. The most promising approaches for preventing and treating NEC are summarized.

Фактор транскрипції T-bet - діагностичний маркер розвитку некротизуючого ентероколіту в недоношених новонароджених

Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease that mainly affects preterm infants. The non-specificity of the clinical picture and the high percentage of complications determine the need for early diagnosis and prevention of the disease. Purpose - to establish a relationship between the T-bet expression level in the cells of the buccal mucosa, the development of HEC and the method of feeding in premature newborn infants. Materials and methods. We examined 74 newborns, who were treated in neonatal departments. We selected three groups for comparison: the Group 1 consisted of 32 newborns up to 37 weeks of gestation on breastfeeding (BF); the Group 2 - 30 preterm newborns on artificial feeding (AF); the control group - 12 full-term newborns on BF. We determined the expression level of T-bet transcription gene factor in the cells of the buccal mucosa scrapings of the newborns. Thereafter, we have calculated the T-bet normalized expression levels in the cells of the mucous membranes of infants of the Group 1 and the Group 2 in relation to the control group, where the expression level of the specified factors was taken as 1 c.u. Results. The gestational age median of the Group 1 children was 33 (31; 34) weeks; the Group 2 - 32.5 (32; 35) weeks; and it was comparatively higher versus in the Group 1 (p&lt;0.001) - 40 (39; 41) weeks. NEC has significantly more often developed in premature children on AF than on BF (p&lt;0.05) - 30.0±8.4% versus 9.4±5.2%. The T-bet expression in the cells of the buccal mucosa scrapings was higher in preterm children, and the highest level was in the Group 2 - 2.4 (1.98; 3.84) c.u. versus 1.48 (1.13; 2.22) c.u. in the Group 1. We have proved a direct relationship between AF and T-bet level (r=0.370; p&lt;0.004). Pairwise comparison revealed a higher level of T-bet in children with NEC (p=0.002): 2.36 (1.94; 3.17) c.u versus 1.74 (1.01; 3.27) c.u. without signs of NEC. We found a direct correlation between the T-bet level and the development of HEC (r=0,271; p=0.021). Conclusions. The T-bet expression level in the cells of the buccal mucosa increases in newborns with the appearance of the clinical signs of NEC. The level of T-bet expression in the buccal mucosa cells can be a marker of the inflammatory process development in intestine of infants. The expression of T-bet in the buccal mucosa cells of newborns with clinical signs of NEC is higher than in full-term newborns that reflects the tendency to NEC development. We have demonstrated that the T-bet expression level is higher in preterm neonates on AF. Therefore, AF can be considered as a risk factor for the development of NEC in preterm infants. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Association of necrotizing enterocolitis with antimicrobial exposure in preterm infants

Objective: To assess the risk of necrotizing enterocolitis (NEC) and explore the relationship between antibiotic overexposure and disease occurrence in a large prospective birth cohort. Methods: Based on a prospective birth cohort, the study collected hospitalization data of very preterm infants (VPIs) having gestational age of less than 32 weeks from January 1, 2018, to June 30, 2021 via the China Northern Neonatal Network. Infants diagnosed with NEC ≥ stage II were included in the case group, and each case was matched for GA and birth weight for the control group. Furthermore, the risk factors for NEC were determined by statistical analyses. Results: A total of 6425 VPIs were included in this study, and 167 (2.6%) of these subjects were diagnosed with NEC ≥ stage II. The study also included 984 extremely preterm infants (gestational age <28 weeks), including 50 (5.1%) infants diagnosed with NEC ≥ stage II. In the matched case-control study, subjects had a total of antibiotic days-of-therapy for 9015 days, of which broad-spectrum antibiotics (BSAs) accounted for 77%. The antibiotic spectrum index per antibiotic day in the case group was significantly higher and was an independent risk factor for the occurrence of NEC (p = 0.001, OR = 1.13). Conclusion: The cohort of VPIs was overexposed to antiboitics. Unreasonable combination of antibiotics and overexposure to BSAs may increase the risk of NEC in preterm infants.

Risk factors for necrotizing enterocolitis in preterm infants: a Meta analysis.

To systematically evaluate the risk factors for necrotizing enterocolitis (NEC) in preterm infants. PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data were searched for case-control studies and cohort studies on the risk factors for NEC in preterm infants published up to December 2021. RevMan 5.3 software was used to perform the Meta analysis. A total of 38 studies were included (28 case-control studies and 10 cohort studies). The Meta analysis showed that maternal gestational diabetes (OR=2.96, P<0.001), intrahepatic cholestasis during pregnancy (OR=2.53, P<0.001), preeclampsia (OR=1.73, P=0.020), history of neonatal asphyxia (OR=2.13, P<0.001), low gestational age (OR=1.23, P=0.010), sepsis (OR=5.32, P<0.001), patent ductus arteriosus (OR=1.57, P=0.001), congenital heart disease (OR=3.78, P<0.001), mechanical ventilation (OR=2.23, P=0.020), history of antibiotic use (OR=1.07, P<0.001), use of vasopressors (OR=2.34, P=0.040), and fasting (OR=1.08, P<0.001) were risk factors for NEC in preterm infants, while cesarean section (OR=0.73, P=0.004), use of pulmonary surfactant (OR=0.43, P=0.008), and breastfeeding (OR=0.24, P=0.020) were protective factors against NEC. Maternal gestational diabetes, intrahepatic cholestasis during pregnancy, preeclampsia, low gestational age, fasting, sepsis, patent ductus arteriosus, congenital heart disease, and histories of asphyxia, mechanical ventilation, antibiotic use, and use of vasopressors may increase the risk of NEC in preterm infants, while cesarean section, use of pulmonary surfactant, and breastfeeding may decrease the risk of NEC in preterm infants.

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.

The Mean Platelet Volume Combined with Procalcitonin as an Early Accessible Marker Helps to Predict the Severity of Necrotizing Enterocolitis in Preterm Infants.

PurposeThis study aims to evaluate the value of the mean platelet volume (MPV) combined with procalcitonin (PCT) in predicting the severity of necrotizing enterocolitis (NEC) in preterm infants.MethodsThis was a retrospective cohort study conducted in a neonatal intensive care unit from January 2014 to July 2020. Premature neonates with NEC were enrolled. In this study, mild-moderate NEC was defined as Bell’s stage I and II, and severe NEC was defined as Bell’s stage III. The demographic data, blood cell count analysis, C-reactive protein and PCT were compared between the severe and mild-moderate groups.ResultsA total of 18 premature infants with NEC in the severe group and 57 infants in the mild-moderate group were enrolled. The MPV and PCT were all significantly higher in the severe group than in the mild-moderate group (P < 0.01), and white blood cells were lower in the severe group (P < 0.05). The results of logistic regression suggested that the MPV (OR = 6.194, P = 0.000) and PCT (OR = 1.093, P = 0.006) were independent predictive factors for the severity of NEC. A receiver operating characteristic analysis showed that the areas under the curve (AUCs) were 0.829 for MPV alone, 0.706 for PCT alone, and 0.895 for MPV combined with PCT.ConclusionThe combination of MPV with PCT had the highest overall AUC of the investigated parameters, and their combination can be considered an early marker for predicting the severity of NEC in preterm infants.

Некротичний ентероколіт у передчасно народжених дітей, які померли: причини, фактори ризику летальності, гістологічні зміни в стінці кишки

Despite advances in the diagnosis and treatment of necrotizing enterocolitis (NEC), the associated morbidity and mortality rates remain high. Purpose - to establish risk factors for mortality of necrotizing enterocolitis in preterm born infants, as well as to analyze histological changes of the intestinal lining. Materials and methods. The course of NEC in 21 preterm neonates who died of this disease (group 1, n=21) over a period of 3 years was analyzed. To establish risk factors for mortality rate health indicators of children in group 1 were compared with the course of NEC in children who survived with similar stages of the disease (group 2, n=43). The following research methods were used: general clinical, laboratory, instrumental, histological and statistical. Results. Our data show that the main causes of severe stages of NEC in preterm infants is infection, often in combination with severe asphyxia. The identified risk factors for mortality allowed to establish that the risk of death for children with NEC was associated with: male sex (OR=4.675; χ2=7.679; p=0.006) - increases the risk for mortality by 4 time; inflammatory changes in the placenta (OR=6.139; χ2=10.501; p=0.002) - increases the risk by 6 times; red blood cell transfusion in children (OR=8.262; χ2=8.557; p=0.004) - increases the risk by 8 times; thrombocytopenia (OR=4.320; χ2=4.866; p=0.028) - increases the risk by 4 time; the developmen of multiple organ system failure (OR=12.364; χ2=17.578; p&lt;0.001) and DIC syndrome (OR=10.725; χ2=14.592; p&lt;0.001) - increases the risk by 12 and 11 times, respectively; the positive symptoms - oedema of the anterior abdominal wall (OR=14.025; χ2=19.258; p&lt;0.001) and vasodilation of the anterior abdominal l wall (OR=5.333; χ2=5.444; p=0.02) - increases the risk by 14 and 5 times, respectively; the intestinal pneumatosis on abdominal when x-ray detected (OR=6.840; χ2=6.867; p=0.009) and the peritoneal effusion detected by abdominal ultrasound (OR=8.750; χ2=14.448; p&lt;0.001) - increases the risk of mortality by 7 and 9 times, respectively. During histological examination of the intestinal wall with NEC lymphohistiocytic infiltration of submucosa indicates perinatal hypoxia and its crucial role in the thanatogenesis of the disease, while polymorphonuclear segmental neutrophil infiltration is associated with perinatal infection. In 15 children (71.4%) changes of both types were noted, which indicates mixed etiology of intestinal lesions. Conclusions. Study results confirmed that necrotizing enterocolitis is a serious disease of newborns with a high mortality rate. The severe forms of NEC occur against the background of infection in combination with hypoxia. The obtained risk factors for the mortality rate of NEC allow to improve the prognosis of the course of this disease, will provide an opportunity to identify children who need increased attention of doctors to the treatment and further management of these patients with the use of preventive technologies that can prevent catastrophic consequences. The presence of congenital intestinal defects in combination with premature birth contribute to the development and aggravate the course of NEC, up to the development of stage III and a negative prognosis of the disease. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the parents of patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: necrotizing enterocolitis, preterm neonates, risk factors for mortality, histological changes.

The Role of Dietary Fats in the Development and Prevention of Necrotizing Enterocolitis.

Necrotizing enterocolitis (NEC) is a significant cause of mortality and morbidity in preterm infants. The pathogenesis of NEC is not completely understood; however, intestinal immaturity and excessive immunoreactivity of intestinal mucosa to intraluminal microbes and nutrients appear to have critical roles. Dietary fats are not only the main source of energy for preterm infants, but also exert potent effects on intestinal development, intestinal microbial colonization, immune function, and inflammatory response. Preterm infants have a relatively low capacity to digest and absorb triglyceride fat. Fat may thereby accumulate in the ileum and contribute to the development of NEC by inducing oxidative stress and inflammation. Some fat components, such as long-chain polyunsaturated fatty acids (LC-PUFAs), also exert immunomodulatory roles during the early postnatal period when the immune system is rapidly developing. LC-PUFAs may have the ability to modulate the inflammatory process of NEC, particularly when the balance between n3 and n6 LC-PUFAs derivatives is maintained. Supplementation with n3 LC-PUFAs alone may have limited effect on NEC prevention. In this review, we describe how various fatty acids play different roles in the pathogenesis of NEC in preterm infants.