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Comparison of Risk Factors in Necrotizing Enterocolitis among Infants in Neonatal Intensive Care Unit

Year 2013, Volume: 38 Issue: 4, 642 - 647, 01.12.2013

Abstract

Purpose: Necrotizing enterocolitis is one of the important problems of premature infants. The incidence is about 1-5% in infants followed in neonatal care units and inversely related to gestational age and birth weight. Materials and Methods: In this study, 31 infants with necrotizing enterocolitis and 31 infants with similar gestational age and birth weight as control group hospitalized in Cukurova University Neonatal Care Unit between 1 January 2001-31 January 2004 were evaluated. Results: The incidence of necrotizing enterocolitis in this period was 1.4 (31/2214 admission). Mean gestational age was 30.5  3.2 weeks (25-36), mean birth weight was 1331  384 (730-2150) grams while 71% was younger than 32 gestational weeks and 67.7% was under 1500 grams. The signs of NEC were detected at a mean of 11.2  10. (2-38) days. Twenty-six (83.9%) were being fed at the time of the necrotizing enterocolitis signs appeared. According to the Walsh and Kliegman classification, 19 (61.3%) infants were in stage 1 (17 were 1a, 2 were 1b); 3 (9.6%) infants were in stage 2a, 9 (%29.1) infants were in stage 3 (7 were in 3b). Blood culture was positive in 7 (%22.6) infants with predominance of gram negative microorganisms (5 infants). Eleven (%35.5) infants were exitus, 12 were discharged. Hypoxia, respiratory distress syndrome, intraventricular hemorrhage and umbilical catheterization were significant risk factors in necrotizing enterocolitis . Thrombocytopenia, leucopenia and high C-reactive protein levels were significantly high in necrotizing enterocolitis group. Breast feeding is significantly high in control group. Conclusion: Necrotizing enterocolitis, is a leading cause of morbidity and mortality in neonatal intensive care units. Early breast feeding with small amounts, increasing amount of milk slowly, antenatal steroids, caring hygiene rules can prevent the development of it.

References

  • Stoll BJ. Epidemiology of necrotising enterocolitis. Clin Perinatol. 1994; 21:215-8.
  • Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978; 187:1-7.
  • Precioso AR, Proenca RS. Necrotizing enterocolitis, pathogenesis and the protector effect of prenatal corticosteroids. Rev Hosp Clin Fac Med Sao Paulo. 2002 ;57:243-8.
  • Uauy RD, Fanaroff AA, Korones SB, Phillips EA, Phillips JB, Wright LL. Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical correlates. J Pediatr. 1991; 119:630-8.
  • Ryder RW, Shelton JD, Guinan ME. Necrotizing enterocolitis: a prospective multicenter investigation. Am J Epidemiol. 1980 ;112: 113-23.
  • Kliegman RM, Fanaroff AA. Necrotizing enterocolitis. N Engl J Med. 1984 26; 1093-103.
  • Stoll BJ, Kanto WP Jr, Glass RI, Nahmias AJ, Brann AW Jr. Epidemiology of necrotizing enterocolitis: a case control study. J Pediatr. 1980; 96:447-51.
  • De Curtis M, Paone C, Vetrano G, Romano G, Paludetto R, Ciccimarra F. A case control study of necrotizing enterocolitis occurring over 8 years in a neonatal intensive care unit. Eur J Pediatr. 1987; 146:398-400.
  • Lee JS, Polin RA. Treatment and prevention of necrotizing enterocolitis. Semin Neonatol. 2003 ;8:449-59.
  • Lucas A, Cole TJ. Breast milk and neonatal necrotizing enterocolitis. Lancet 1990;336:1519-23.
  • Kleessen B, Bunke H, Tovar K, Noack J, Sawatzki G. Influence of two infant formulas and human milk on the development of the faecal flora in newborn infants. Acta Paediatr. 1995 ;84:1347-56.
  • Boccia D, Stolfi I, Lana S, Moro ML. Nosocomial necrotizing enterocolitis outbreaks: epidemiology and control measures. Eur J Pediatr. 2001 ;160:385-91.
  • Yost CC. Neonatal necrotizing enterocolitis: diagnosis, management, and pathogenesis. J Infus Nurs. 2005; ;28:130-4.
  • Peter CS, Feuerhahn M, Bohnhorst B, et al. Necrotizing enterocolitis: is there a relationship to specific pathogens? Eur J Pediatr. 1999;158:67-70.
  • Duffy LC, Zielezny MA, Carrion V, et al. Bacterial toxins and enteral feeding of premature infants at risk for necrotizing enterocolitis. Adv Exp Med Biol. 2001; 501:519-27.
  • Mollitt DL, Tepas JJ, Talbert JL. The role of coagulase-negative Staphylococcus in neonatal necrotizing enterocolitis. J Pediatr Surg. 1988; 23:60
  • Scheifele DW, Bjornson GL, Dyer RA, Dimmick JE. Delta-like toxin produced by coagulase-negative staphylococci is associated with neonatal necrotizing enterocolitis. Infect Immun. 1987 ;55: 2268-73.
  • Rotbart HA, Nelson WL, Glode MP, et al. Neonatal rotavirus-associated necrotizing enterocolitis: case control study and prospective surveillance during an outbreak. J Pediatr. 1988; 112:87-93.
  • Rowe MI, Reblock KK, Kurkchubasche AG, Healey PJ. Necrotizing enterocolitis in the extremely low birth weight infant. J Pediatr Surg 1994; 29:987-90.
  • Yazışma Adresi / Address for Correspondence: Dr. Ferda Özlü Cukurova University Faculty of Medicine, Neonatology Department, ADANA e-mail: fozlu@cu.edu.tr geliş tarihi/received :07.03.2013 kabul tarihi/accepted:04.04.2013

Yenidoğan Yoğun Bakım Ünitesindeki Bebeklerin Nekrotize Enterokolit Risk Faktörlerinin Karşılaştırılması

Year 2013, Volume: 38 Issue: 4, 642 - 647, 01.12.2013

Abstract

Amaç: Nekrotize enterokolit prematüre bebeklerde rastlanan en önemli problemlerden biridir. Yenidoğan bakım ünitesindeki bebeklerin %1-5'inde görülmekte olup gebelik yaşı ve doğum ağırlığı ile ters orantılıdır. Materyal ve Metod: Bu çalışmada Çukurova Üniversitesi Yenidoğan Bakım Ünitesinde 1 Ocak 2001- 31 Ocak 2004 yılları arasında nekrotize enterokolit tanısı konan 31 bebek ile aynı gebelik yaşı ve doğum ağırlığına sahip kontrol grubu karşılaştırmalı olarak değerlendirilmiştir. Bulgular: Bu dönemdeki nekrotize enterokolit görülme sıklığı 1,4 (31/ 2214 kabul edilen hasta) olarak belirlenmiştir. Ortalama gebelik yaşı 30,5±3,2 hafta (25-36), Ortalama doğum ağırlığı 1331±384 (730-2150) gramken %71'i 32 gebelik haftasından erken ve %67,7'si 1500 gr'ın altında idi. NEC semptomlarının saptanama süresi ortalama 11,2±10 (2-38) gündür. Bebeklerin 26'sı (%83,9) nekrotize enterokolit belirtileri ortaya çıktığında düzenli olarak besleniyorlardı. beslenme sırasında NEC'e rastlanmıştır. Walsh ve Kliegman sınıflandırmasına göre; bebeklerin 19'u 1. Evrede (17"si 1a, ikisi 1b), Üçü 2a evresinde, dokuzu üçüncü evrede (Yedisi 3b) sınıflandırılmıştır. Kan kültürünün 7 (%22.6) bebekte pozitif çıktığı ve bunların beşinde gram negatif mikroorganizmalar olduğu tespit edilmiştir. Bebeklerin onbirinde (%35.5) ölüm gerçekleştiği, 12'sininde taburcu olduğu saptanmıştır. Hipoksi, respiratuar distres sendromu, intraventrikuler kanama ve umbilikal katater uygulaması nekrotize enterokolitteki önemli risk faktörleridir. Trombositopeni, lökopeni, ve C-reaktif proteinindeki artış nekrotize enterokolitli grupta oldukça yükselmiştir. Emzirme kontrol grubunda oldukça yüksektir. Sonuç: Nekrotize enterokolit yenidoğan bakım ünitelerinde en sık hastalık ve ölüme yolaçan nedenlerden biridir. Az miktarlarda erken emzirme, sütün yavaşça miktarının artırılması, antenatal steroidler ve hijyen kurallarının önemsenmesiyle bu hastalığın gelişiminin önüne geçilebilir.

References

  • Stoll BJ. Epidemiology of necrotising enterocolitis. Clin Perinatol. 1994; 21:215-8.
  • Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978; 187:1-7.
  • Precioso AR, Proenca RS. Necrotizing enterocolitis, pathogenesis and the protector effect of prenatal corticosteroids. Rev Hosp Clin Fac Med Sao Paulo. 2002 ;57:243-8.
  • Uauy RD, Fanaroff AA, Korones SB, Phillips EA, Phillips JB, Wright LL. Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical correlates. J Pediatr. 1991; 119:630-8.
  • Ryder RW, Shelton JD, Guinan ME. Necrotizing enterocolitis: a prospective multicenter investigation. Am J Epidemiol. 1980 ;112: 113-23.
  • Kliegman RM, Fanaroff AA. Necrotizing enterocolitis. N Engl J Med. 1984 26; 1093-103.
  • Stoll BJ, Kanto WP Jr, Glass RI, Nahmias AJ, Brann AW Jr. Epidemiology of necrotizing enterocolitis: a case control study. J Pediatr. 1980; 96:447-51.
  • De Curtis M, Paone C, Vetrano G, Romano G, Paludetto R, Ciccimarra F. A case control study of necrotizing enterocolitis occurring over 8 years in a neonatal intensive care unit. Eur J Pediatr. 1987; 146:398-400.
  • Lee JS, Polin RA. Treatment and prevention of necrotizing enterocolitis. Semin Neonatol. 2003 ;8:449-59.
  • Lucas A, Cole TJ. Breast milk and neonatal necrotizing enterocolitis. Lancet 1990;336:1519-23.
  • Kleessen B, Bunke H, Tovar K, Noack J, Sawatzki G. Influence of two infant formulas and human milk on the development of the faecal flora in newborn infants. Acta Paediatr. 1995 ;84:1347-56.
  • Boccia D, Stolfi I, Lana S, Moro ML. Nosocomial necrotizing enterocolitis outbreaks: epidemiology and control measures. Eur J Pediatr. 2001 ;160:385-91.
  • Yost CC. Neonatal necrotizing enterocolitis: diagnosis, management, and pathogenesis. J Infus Nurs. 2005; ;28:130-4.
  • Peter CS, Feuerhahn M, Bohnhorst B, et al. Necrotizing enterocolitis: is there a relationship to specific pathogens? Eur J Pediatr. 1999;158:67-70.
  • Duffy LC, Zielezny MA, Carrion V, et al. Bacterial toxins and enteral feeding of premature infants at risk for necrotizing enterocolitis. Adv Exp Med Biol. 2001; 501:519-27.
  • Mollitt DL, Tepas JJ, Talbert JL. The role of coagulase-negative Staphylococcus in neonatal necrotizing enterocolitis. J Pediatr Surg. 1988; 23:60
  • Scheifele DW, Bjornson GL, Dyer RA, Dimmick JE. Delta-like toxin produced by coagulase-negative staphylococci is associated with neonatal necrotizing enterocolitis. Infect Immun. 1987 ;55: 2268-73.
  • Rotbart HA, Nelson WL, Glode MP, et al. Neonatal rotavirus-associated necrotizing enterocolitis: case control study and prospective surveillance during an outbreak. J Pediatr. 1988; 112:87-93.
  • Rowe MI, Reblock KK, Kurkchubasche AG, Healey PJ. Necrotizing enterocolitis in the extremely low birth weight infant. J Pediatr Surg 1994; 29:987-90.
  • Yazışma Adresi / Address for Correspondence: Dr. Ferda Özlü Cukurova University Faculty of Medicine, Neonatology Department, ADANA e-mail: fozlu@cu.edu.tr geliş tarihi/received :07.03.2013 kabul tarihi/accepted:04.04.2013
There are 20 citations in total.

Details

Primary Language Turkish
Journal Section Research
Authors

Ferda Özlü This is me

Hacer Yapicioglu This is me

Nejat Narlı This is me

Mehmet Satar This is me

Kenan Ozcan This is me

Recep Tuncer This is me

Publication Date December 1, 2013
Published in Issue Year 2013 Volume: 38 Issue: 4

Cite

MLA Özlü, Ferda et al. “Yenidoğan Yoğun Bakım Ünitesindeki Bebeklerin Nekrotize Enterokolit Risk Faktörlerinin Karşılaştırılması”. Cukurova Medical Journal, vol. 38, no. 4, 2013, pp. 642-7.