Does abdominal sonography provide additional information over abdominal plain radiography for diagnosis of necrotizing enterocolitis in neonates?

Purpose  

To explore whether addition of abdominal sonography (AUS) to plain radiography is helpful in the management of premature newborns with necrotizing enterocolitis (NEC).     

Does necrotizing enterocolitis affect growth and neurodevelopmental outcome in very low birth weight infants?

Aim  

To evaluate the effect of necrotizing enterocolitis (NEC) on growth and neurodevelopmental outcome.     

Interval between clinical presentation of necrotizing enterocolitis and bowel perforation in neonates

Objective  

To define the interval between clinical presentation of necrotizing enterocolitis (NEC) and bowel perforation in neonates.     

Protective effects of caffeic acid phenethyl ester (CAPE) on intestinal damage in necrotizing enterocolitis

Objective  

To determine the preventative effect of caffeic acid phenethyl ester (CAPE) in necrotizing enterocolitis (NEC) in an experimental rat model of NEC.     

The efficacy of serial serum amyloid A measurements for diagnosis and follow-up of necrotizing enterocolitis in premature infants

Purpose  

The purpose of this study was to evaluate the efficacy of serial serum amyloid A (SAA) measurements in diagnosis and follow-up of necrotizing enterocolitis (NEC) in preterm infants.     

Could clinical scores guide the surgical treatment of necrotizing enterocolitis?

Purpose  

Test the diagnostic reliability of the score for neonatal acute physiology-perinatal extension-II (SNAPPE-II) and the metabolic derangement acuity score (MDAS) as predictors of surgery in patients with necrotizing enterocolitis (NEC).     

Diagnosis and outcome of neutropenic enterocolitis: experience in a single tertiary pediatric surgical center in China

Background/purpose  

Neutropenic enterocolitis (NE) is clinically defined by the triad of neutropenia, abdominal pain and fever. This retrospective study is to review 24 cases of NE in a single Chinese tertiary center, to elucidate clinical feature, treatments and outcome for this dangerous gastrointestinal complication of neutropenia.     

Bowel sonography in sepsis with pathological correlation: an experimental study

Background  

Sepsis predisposes full-term infants to necrotizing enterocolitis (NEC). As such, experimental induction of NEC was applied to a sepsis model to evaluate the potential role of US in the early diagnosis of NEC in full-term infants.     

Splenic lymphopenia in the endothelin receptor B-null mouse: implications for Hirschsprung associated enterocolitis

Purpose  

The aim of the study was to describe and characterize a novel small spleen phenotype with splenic lymphopenia in the Ednrb-null (Ednrb−/−) mouse with aganglionosis known to also develop enterocolitis.     

Homocysteine levels in preterm infants: is there an association with intraventricular hemorrhage? a prospective cohort study

Background  

The purpose of this study was to characterize total homocysteine (tHcy) levels at birth in preterm and term infants and identify associations with intraventricular hemorrhage (IVH) and other neonatal outcomes such as mortality, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, and thrombocytopenia.     

Long-term outcome of surgically managed necrotizing enterocolitis in a developing country

Abstract  

Necrotizing enterocolitis (NEC) is a serious condition with a high morbidity and mortality commonly affecting premature babies. Data for the impact of the long-term disease burden in developing countries are limited although poor long-term outcome of surgically managed patients has been shown in terms of increased risk of neurodevelopmental delay, increased infectious disease burden and abnormal neurological outcomes in the developed world.     

Cytomegalovirus Enterocolitis in a Term Neonate

Background

Cytomegalovirus (CMV) enterocolitis is rare in term neonates.

Case characteristics

A term newborn with persistent pneumonia from birth developed enterocolitis on day 18 of life.

Outcome

Polymerase chain reaction (PCR) for CMV DNA was positive in urine sample. Antiviral therapy for six weeks resulted in successful treatment without any stricture formation.

Message

CMV enterocolitis should be considered as a differential diagnosis in atypical cases of necrotizing enterocolitis in neonates.

     

Outcomes analysis after percutaneous abdominal drainage and exploratory laparotomy for necrotizing enterocolitis in 4,657 infants

Purpose  

Necrotizing enterocolitis (NEC) is a common acquired gastrointestinal disease of infancy that is strongly correlated with prematurity. Both percutaneous abdominal drainage and laparotomy with resection of diseased bowel are surgical options for treatment of NEC. The objective of the present study is to compare outcomes of patients who were treated either with bowel resection/ostomy (BR/O), percutaneous drainage (PD) or Both procedures for NEC in a retrospective analysis.     

Intestinal mitochondrial apoptotic signaling is activated during oxidative stress

Purpose  

Reactive oxygen species (ROS) are thought to contribute to the pathogenesis of necrotizing enterocolitis (NEC). Mitochondria as a major source of intracellular ROS and apoptotic signaling during oxidative stress in NEC have not been investigated. We sought to determine: (1) the effects of oxidative stress on intestinal mitochondrial apoptotic signaling, and (2) the role of growth factors in this process.     

Seasonal variation in the incidence of necrotizing enterocolitis

Background  

Necrotizing enterocolitis (NEC) has been reported to occur in a sporadic manner and in clusters of cases. We hypothesized that variations in the incidence of NEC were random, without clustering. In order to define the pattern of NEC in the United States, we analyzed the Pediatric Health Information System (PHIS) database to evaluate whether NEC cases are distributed randomly or exhibit temporal clustering or periodicity.     

Transanal endorectal pull-through for Hirschsprung's disease using long cuff dissection and short V-shaped partially resected cuff anastomosis: early and late outcomes

Background  

Transanal endorectal pull-through was described by De la Torre-Mondragon’s technique. In the original transanal pull-through procedure, a long rectal muscular cuff was dissected and left for anocolic anastomosis, which would sometimes lead to postoperative obstructive symptoms and enterocolitis. While a modified short mucosal dissection may increase the risk of injury to pelvic and perirectal nerves and other structures when dissected on the outside of the rectum deep in the pelvis. We report early and late results of the modified transanal procedure for Hirschsprung’s disease (HD) over 8 years.     

Systematic review and meta-analysis of enterocolitis after one-stage transanal pull-through procedure for Hirschsprung’s disease

Purpose  

The transanal one-stage pull-through procedure (TERPT) has gained worldwide popularity over open and laparoscopic-assisted one-stage techniques in children with Hirschsprung’s disease (HD). It offers the advantages of avoiding laparotomy, laparoscopy, scars, abdominal contamination, and adhesions. However, enterocolitis associated with Hirschsprung’s disease (HAEC) still remains to be a potentially life-threatening complication after pull-through operation. The reported incidence of HAEC ranges from 4.6 to 54%. This meta-analysis was designed to evaluate postoperative incidence of HAEC following TERPT procedure.     

A prospective comparison of intestinal sonography and abdominal radiographs in a neonatal intensive care unit

Background

No study reported in the literature comprehensively compares findings on neonatal abdominal radiographs with sonography.

Objective

To compare the findings on abdominal radiographs and sonograms in infants in intensive care, to better understand how the various intestinal gas patterns on radiographs relate to the spectrum of appearances on sonography and, second, to evaluate the ability of sonography to differentiate necrotizing enterocolitis from other intestinal pathology.

Materials and methods

We prospectively evaluated sonograms and radiographs, blinded to the other modality and to clinical information. Patients’ charts were reviewed by a third blinded reader and used as a reference standard for diagnosis. We made associations between sonographic findings, radiographic intestinal gas patterns and clinical diagnoses.

Results

We included 75 infants with gestational ages between 23 weeks and 41 weeks. Sonographic abnormalities were present in infants with all radiographic intestinal gas patterns, including normal patterns. We only saw absent intestinal perfusion and fluid collections on sonography (suggesting intestinal necrosis and sealed perforation) in infants with intestinal dilatation with elongation on radiographs. Separation of intestinal loops on radiographs was most commonly caused by reasons other than intestinal wall thickening. Increased intestinal echogenicity or free fluid with echoes on sonography correlated with a diagnosis of necrotizing enterocolitis, whereas anechoic free fluid correlated with absence of necrotizing enterocolitis.

Conclusion

Sonography is complementary to radiographs in infants with suspected intestinal pathology, with a spectrum of appearances seen on each modality. Some sonographic findings either strongly suggest necrotizing enterocolitis or supply evidence against this diagnosis.     

ADEPT - Abnormal Doppler Enteral Prescription Trial

Background  

Pregnancies complicated by abnormal umbilical artery Doppler blood flow patterns often result in the baby being born both preterm and growth-restricted. These babies are at high risk of milk intolerance and necrotising enterocolitis, as well as post-natal growth failure, and there is no clinical consensus about how best to feed them. Policies of both early milk feeding and late milk feeding are widely used. This randomised controlled trial aims to determine whether a policy of early initiation of milk feeds is beneficial compared with late initiation. Optimising neonatal feeding for this group of babies may have long-term health implications and if either of these policies is shown to be beneficial it can be immediately adopted into clinical practice.