Clinical and epidemiological characterization of newborns with necrotizing enterocolitis
Main Article Content
Abstract
Introduction: Necrotizing enterocolitis (NEC) is a severe inflammatory disorder that can affect the whole gastrointestinal system, particularly the ileum, and is a major cause of morbidity in premature infants. Objective: To describe the clinical and epidemiological profile of newborns with NEC, seeking to identify the causes, evolution and severity of the disease. Methods: The study selected 94 patients who developed NEC (cases) and 60 patients who did not develop the disease during hospitalization (controls) and presented similar clinical signs of the case group. The variables analyzed divided into maternal and neonatal. The frequency tests were applied using the Statistical Package for the Social Sciences (SPSS) version 21.0 and comparative analysis using the GraphPad Prism® 5.0 software. Results: There was a higher number of prenatal consultations in cases with NEC. Newborns with NEC had shorter hospital stay, longer parenteral nutrition and antibiotics use and a predominant use of infant formula. The Bell criteria modified by Walsh and Kleigman was negatively correlated to maternal age and positively correlated to gestational age, birth weight and time of parenteral nutrition. Conclusion: Although being a disease of the newborn, the present study indicated that maternal characteristics may be related to its onset of NEC. Therefore, the greater number of prenatal consultations and neonatal factors such as length of stay, prolonged use of parenteral nutrition and antibiotic therapy, and formula use may influence the development of the disease.
Downloads
Article Details
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY) that allows others to share and adapt the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.References
Collado MC, Cernada M, Neu J, Pérez-Martínez G, Gormaz M, Vento M. Factors influencing gastrointestinal tract and micro-biota immune interaction in preterm infants. Pediatr Res. 2015;77(6):726-31. https://doi.org/10.1038/pr.2015.54
Vieira AA, David BBL, Lino RRG, Duarte LB, Bueno AC. Avaliação dos fatores perinatais que interferem na incidência de enterocolite necrosante em recém-nascidos de muito baixo peso. Rev Bras Ginecol Obstet. 2013;35(8):363-7. http://dx.doi.org/10.1590/S0100-72032013000800005
Epelman M, Daneman A, Navarro OM, Morag IU, Moore AM, Kim JH, et al. Necrotizing enterocolitis: review of state of the art imaging findings with pathologic correlation. Radiographics. 2007;27(2):285-305. https://doi.org/10.1148/rg.272055098
Fernandez JI, Las Cuevas Terán I. Enterocolitis necrotizante neonatal. Bol Pediatr. 2006;46(supl.1):172-8.
Hunter CJ, Pood B, Ford HR, Camerini V. Evidence vs experience in neonatal practices in necrotizing enterocolitis. J Perinatol. 2008;28(suppl.1):S9-13. https://doi.org/10.1038/jp.2008.43
Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011;364(3):255-64. https://doi.org/10.1056/NEJMra1005408
Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33(1):179-201. https://doi.org/10.1016/S0031-3955(16)34975-6
Neves LAT, Mendes E, Neves DB. Enterocolite necrosante: um desafio para o recém nascido prematuro de muito baixo peso. Rev Med Minas Gerais. 2009;19(1):51-7.
Bueno MB, Reis VS. A importância do leite materno na prevenção da enterocolite necrosante entre recém nascidos. Nutrire. 2011;36(3):266.
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Atenção ao pré-natal de baixo risco. Brasília: Ministério da Saúde, 2012.
Rugolo LMSS, Bentlin MR, Rugolo júnior A, Dalben I, Trindade CEP. Crescimento de prematuros de extremo baixo peso nos primeiros dois anos de vida. Rev Paul Pediatr. 2007;25(2):142-9. http://dx.doi.org/10.1590/S0103-05822007000200008
Cotten CM, Oh W, Mcdonald S, Carlo W, Fanaroff AA, Duara S, et al. Prolonged hospital stay for extremely premature infants. J. Perinatol. 2005;25(10):650-5. https://doi.org/10.1038/sj.jp.7211369
Catlin A. Extremely long hospitalizations of newborns in the United States: data, descriptions, dilemmas. Adv Neonatal Care. 2008;8(2):125-32. https://doi.org/10.1097/01.ANC.0000317261.99072.e7
March MI, Gupta M, Modest AM, Wu L, Hacker MR, Martin CR, et al. Maternal risk factors for neonatal necrotizing enterocolitis. J Matern Fetal Neonatal Med. 2015;28(11):1285-90. https://doi.org/10.3109/14767058.2014.951624
Lee JS, Polin RA. Treatment and prevention of necrotizing enterocolitis. Semin. Neonatol. 2003;8(6):449-59. https://doi.org/10.1016/S1084-2756(03)00123-4
Oliveira ND, Miyoshi MH. Avanços em enterocolite necrosante. J Pediatr. 2005;81(1):16-22. http://dx.doi.org/10.1590/S0021-75572005000200003
Sangild PT, Thymann T, Schmidt M, Stoll B, Burrin DG, Buddington RK. Invited review: the preterm pig as a model in pediatric gastroenterology. J Animal Sci. 2013;91(10):4713-29. https://doi.org/10.2527/jas.2013-6359
Jain AK, Stoll B, Burrin DG, Holst JJ, Moore DD. Enteral bile acid treatment improves parenteral nutrition-related liver disease and intestinal mucosal atrophy in neonatal pigs. Am J Physiol Gastrointest Liver Physiol. 2012;302(2):218-24. https://doi.org/10.1152/ajpgi.00280.2011
Al-Mouqdad MM, Aljobair F, Alaklobi FA, Taha MY, Abdelrahim, Asfour SS. The consequences of prolonged duration of antibiotics in premature infants with suspected sepsis in a large tertiary referral hospital: a retrospective cohort study. Int J Pediatr Adolesc Med. 2018;5(3):110-5. https://doi.org/10.1016/j.ijpam.2018.08.003
Cotten CM, Taylor S, Stoll B, Goldberg RN, Hansen NI, Sánchez PJ, et al. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics. 2009;123(1):58-66. https://doi.org/10.1542/peds.2007-3423
Wang Y, Hoenig JD, Malin KJ, Qamar S, Petrof EO, Sun J, et al. 16S rRNA gene-based analysis of fecal microbiota from preterm infants with and without necrotizing enterocolitis. ISME J. 2009;3(8):944-54. https://doi.org/10.1038/ismej.2009.37
Cianciarullo MA, Costa IC, Ceccon MEJ, Krebs VLJ. Novos x antigos marcadores de infecção no diagnóstico de sepse neonatal: visão crítica. Pediatria. 2008;30(2):107-17.
Goulart LS. Caracterização de recém-nascidos com hemoculturas positivas internados em unidade de terapia intensiva neonatal. Rev Eletrôn Gestão Saúde. 2012;3(2):438-50.
Assad M, Elliott MJ, Abraham JH. Decreased cost and improved feeding tolerance in VLBW infants fed an exclusive human milk diet. J Perinatol. 2016;36(3):216-20. https://doi.org/10.1038/jp.2015.168
Elgin TG, Kern SL, Mcelroy SJ. Development of the neonatal intestinal microbiome and its associati, on with necrotizing enterocolitis. Clin Ther. 2016;38(4):706-15. https://doi.org/10.1016/j.clinthera.2016.01.005
Irles C, González-Pérez G, Muiños SC, Macias CM, Gómes CS, Martínez-Zepeda A, et al. Estimation of neonatal intestinal perforation associated with necrotizing enterocolitis by machine learning reveals new key factors. Int J Environ Res Public Health. 2018;15(11):2509. https://doi.org/10.3390/ijerph15112509
Ahle M, Drott P, Elfvin A, Andersson RE. Maternal, fetal and perinatal factors associated with necrotizing enterocolitis in Sweden. A national case-control study. PLoS One. 2018;13(3):e0194352. https://doi.org/10.1371/journal.pone.0194352
Nair J, Longendyke R, Lakshminrusimha S. Necrotizing enterocolitis in moderate preterm infants. BioMed Res Int. 2018. https://doi.org/10.1155/2018/4126245
Ferreira MCV, Moraes M. Necrotizing enterocolitis in a full term infant. Arch Clin Cases. 2016;3(4):115-9. http://dx.doi.org/10.22551/2016.13.0304.10079