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Risk factors and prevention for surgical intestinal disorders in extremely low birth weight infants

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Abstract

Purpose

Surgical intestinal disorders (SID), such as necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI), are serious morbidities in extremely low birth weight (ELBW, birth weight <1000 g) infants. From 2010, we performed enteral antifungal prophylaxis (EAP) in ELBWI to prevent for SID. The aim of this study was to identify disease-specific risk factors and to evaluate the efficacy of prevention for SID in ELBW infants.

Methods

A retrospective chart review of all consecutive patients between January 2006 and March 2015, which included 323 ELBW infants who were admitted to Shizuoka Children’s Hospital, was conducted.

Results

The number of infants with NEC, FIP, and MRI was 9, 12, and 13, respectively; 28 in 323 ELBW infants died. The control group defined the cases were not SID. In-hospital mortality was higher in infants with NEC relative to those in the control group. On logistic regression analysis, low gestational age and cardiac malformations were associated with increased risk of NEC. IUGR were associated with increased risk of MRI. EAP decreased risk of NEC and FIP. Low gestational weight and NEC were associated with increased risk of death.

Conclusion

Survival to hospital discharge after operation for NEC in ELBW infants remains poor. EAP decreased risk of NEC and FIP in ELBW infants.

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References

  1. Guthrie SO, Gordon PV, Thomas V, Thorp JA, Peabody J, Clark RH (2003) Necrotizing enterocolitis among neonates in the United States. J Perinatol 23:278–285

    Article  PubMed  Google Scholar 

  2. Hull MA, Fisher JG, Gutierrez IM, Jones BA, Kang KH, Kenny M, Zurakowski D, Modi BP, Horbar JD, Jaksic T (2014) Mortality and management of surgical necrotizing enterocolitis in very low birth weight neonates: a prospective cohort study. J Am Coll Surg 218:1148–1155

    Article  PubMed  Google Scholar 

  3. Pumberger W, Mayr M, Kohlhauser C, Weninger M (2002) Spontaneous localized intestinal perforation in very-low-birth-weight infants: a distinct clinical entity different from necrotizing enterocolitis. J Am Coll Surg 195:796–803

    Article  PubMed  Google Scholar 

  4. Blakely ML, Lally KP, McDonald S, Brown RL, Barnhart DC, Ricketts RR, Thompson WR, Scherer LR, Klein MD, Letton RW, Chwals WJ, Touloukian RJ, Kurkchubasche AG, Skinner MA, Moss RL, Hilfiker ML (2005) Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation: a prospective cohort study by the NICHD Neonatal Research Network. Ann Surg 241:984–994

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kubota A, Shiraishi J, Kawahara H, Okuyama H, Yoneda A, Nakai H, Nara K, Kitajima H, Fujimura M, Kuwae Y, Nakayama M (2011) Meconium-related ileus in extremely low-birthweight neonates: etiological considerations from histology and radiology. Pediatr Int 53:887–891

    Article  PubMed  Google Scholar 

  6. Coates EW, Karlowicz MG, Croitoru DP, Buescher ES (2005) Distinctive distribution of pathogens associated with peritonitis in neonates with focal intestinal perforation compared with necrotizing enterocolitis. Pediatrics 116:241–246

    Article  Google Scholar 

  7. Tam AL, Camberos A, Applebaum H (2002) Surgical decision making in necrotizing enterocolitis and focal intestinal perforation: predictive value of radiologic findings. J Pediatr Surg 37:1688–1691

    Article  PubMed  Google Scholar 

  8. Hwang H, Murphy JJ, Gow KW, Magee JF, Bekhit E, Jamieson D (2003) Are localized intestinal perforations distinct from necrotizing enterocolitis? J Pediatr Surg 38:763–767

    Article  PubMed  Google Scholar 

  9. Okuyama H, Ohfuji S, Hayakawa M, Urushihara N, Yokoi A, Take H, Shiraishi J, Fujinaga H, Ohashi K, Minagawa K, Misaki M, Nose S, Taguchi T (2016) Risk factors for surgical intestinal disorders in VLBW infants: case–control study. Pediatr Int 58:34–39

    Article  PubMed  Google Scholar 

  10. Luton A (2013) Transfusion-associated necrotizing enterocolitis: translating knowledge into nursing practice. Neonatal Netw 32:167–174

    Article  PubMed  Google Scholar 

  11. Luig M, Lui K (2005) Epidemiology of necrotizing enterocolitis—part II: risks and susceptibility of premature infants during the surfactant era: a regional study. J Paediatr Child Health 41:174–179

    Article  PubMed  Google Scholar 

  12. Downard CD, Grant SN, Maki AC, Krupski MC, Matheson PJ, Bendon RW, Fallat ME, Garrison RN (2012) Maternal cigarette smoking and the development of necrotizing enterocolitis. Pediatrics 130:78–82

    Article  PubMed  Google Scholar 

  13. Saura L, Munoz ME, Castanon M, Eixarch E, Corradini M, Aguilar C, Ma Ribo J (2010) Intestinal complications after antenatal fetoscopic laser ablation in twin-to-twin transfusion syndrome. J Pediatr Surg 45:5–8

    Article  Google Scholar 

  14. Cetinkaya M, Ozkan H, Koksal N (2012) Maternal preeclampsia is associated with increased risk of necrotizing enterocolitis in preterm infants. Early Hum Dev 88:893–898

    Article  PubMed  Google Scholar 

  15. Paquette L, Friedlich P, Ramanathan R, Seri I (2006) Concurrent use of indomethacin and dexamethasone increases the risk of spontaneous intestinal perforation in very low birth weight neonates. J Perinatol 26:486–492

    Article  CAS  PubMed  Google Scholar 

  16. Attridge JT, Clark R, Walker MW, Gordon PV (2006) New insights into spontaneous intestinal perforation using a national data set: (1) SIP is associated with early indomethacin exposure. J Perinatol 26:93–99

    Article  CAS  PubMed  Google Scholar 

  17. Emil S, Nguyen T, Sills J, Padilla G (2004) Meconium obstruction in extremely low-birth-weight neonates: guidelines for diagnosis and management. J Pediatr Surg 39:731–737

    Article  PubMed  Google Scholar 

  18. Greenholz SK, Perez C, Wesley JR, Marr CC (1996) Meconium obstruction in markedly premature infant. J Pediatr Surg 31:117–120

    Article  CAS  PubMed  Google Scholar 

  19. Itabashi K, Horiuchi T, Kusuda S, Kabe K, Itani Y, Nakamura T, Fujimura M, Matsuo M (2009) Mortality rates for extremely low birth weight infants born in Japan in 2005. Pediatrics 123:445–450

    Article  PubMed  Google Scholar 

  20. Markestad T, Kaaresen PI, Ronnestad A, Reigstad H, Lossius K, Medbo S, Zanussi G, Engelund IE, Skjaerven R, Irgens LM (2005) Early death, morbidity, and need of treatment among extremely premature infants. Pediatrics 115:1289–1298

    Article  PubMed  Google Scholar 

  21. Bizzarro MJ, Ehrenkranz RA, Gallagher PG (2014) Concurrent bloodstream infections in infants with necrotizing enterocolitis. J Pediatr 164:61–66

    Article  PubMed  Google Scholar 

  22. Nowicki PT (2005) Ischemia and necrotizing enterocolitis: where, when, and how. Semin Pediatr Surg 14:152–158

    Article  PubMed  Google Scholar 

  23. Prakash A, Sharma D, Saxena A, Somashekar U, Khare N, Mishra A, Anvikar A (2008) Effect of Candida infection on outcome in patients with perforation peritonitis. Indian J Gastroenterol 27:107–109

    PubMed  Google Scholar 

  24. Mintz AC, Applebaum H (1993) Focal gastrointestinal perforations not associated with necrotizing enterocolitis in very low birth weight neonates. J Pediatr Surg 28:857–860

    Article  CAS  PubMed  Google Scholar 

  25. Bendel CM (2003) Colonization and epithelial adhesion in the pathogenesis of neonatal candidiasis. Semin Perinatol 27:357–364

    Article  PubMed  Google Scholar 

  26. Hallstrom M, Eerola E, Vuento R, Janas M, Tammela O (2004) Effects of mode of delivery and necrotising enterocolitis on the intestinal microflora in preterm infants. Eur J Clin Microbiol Infect Dis 23:463–470

    Article  CAS  PubMed  Google Scholar 

  27. Aydemir C, Oguz SS, Dizdar EA, Akar M, Sarikabadayi YU, Saygan S, Erdeve O, Dilmen U (2011) Randomised controlled trial of prophylactic fluconazole versus nystatin for the prevention of fungal colonisation and invasive fungal infection in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed 96:164–168

    Article  Google Scholar 

  28. Kaufman D, Boyle R, Hazen KC, Patrie JT, Robinson M, Donowitz LG (2001) Fluconazole prophylaxis against fungal colonization and infection in preterm infants. N Engl J Med 345:1660–1666

    Article  CAS  PubMed  Google Scholar 

  29. Cleminson J, Austin N, McGuire W (2015) Prophylactic systemic antifungal agents to prevent mortality and morbidity in very low birth weight infants. Cochrane Database Syst Rev 10:Cd003850

    PubMed  Google Scholar 

  30. Barton M, O’Brien K, Robinson JL, Davies DH, Simpson K, Asztalos E, Langley JM, Le Saux N, Sauve R, Synnes A, Tan B, de Repentigny L, Rubin E, Hui C, Kovacs L, Richardson SE (2014) Invasive candidiasis in low birth weight preterm infants: risk factors, clinical course and outcome in a prospective multicenter study of cases and their matched controls. BMC Infect Dis 14:327

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Surgery, Shizuoka Children’s Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan

    Masaya Yamoto, Koji Fukumoto, Hiromu Miyake, Hideaki Nakajima, Akinori Sekioka, Akiyoshi Nomura, Kei Ooyama, Yutaka Yamada & Naoto Urushihara

  2. Department of Neonatalogy, Shizuoka Children’s Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan

    Yusuke Nakazawa, Katsushi Nogami, Yuko Van, Chisako Furuta, Reiji Nakano & Yasuhiko Tanaka

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  1. Masaya Yamoto
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  2. Yusuke Nakazawa
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  3. Koji Fukumoto
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Correspondence to Masaya Yamoto.

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Yamoto, M., Nakazawa, Y., Fukumoto, K. et al. Risk factors and prevention for surgical intestinal disorders in extremely low birth weight infants. Pediatr Surg Int 32, 887–893 (2016). https://doi.org/10.1007/s00383-016-3940-z

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  • DOI: https://doi.org/10.1007/s00383-016-3940-z

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