Advertisement

Pediatric Surgery International

, Volume 21, Issue 12, pp 977–982 | Cite as

Neonatal gut injury and infection rate: impact of surgical debridement on outcome

  • Renu SharmaEmail author
  • Joseph J. TepasIII
  • Mark L. Hudak
  • Pam Pieper
  • Ru-Jeng Teng
  • Savithri Raja
  • Monica Sharma
Original article

Abstract

Infectious burden of gut injury (G-INJ) associated with necrotizing enterocolitis (NEC) or with spontaneous intestinal perforation (SIP) in neonates has not been ascertained. We sought to test the hypotheses that: (1) infants with G-INJ develop higher number of infections including non-concurrent infections than infants without G-INJ in a neonatal intensive care unit (NICU); (2) surgical debridement (DEB) of infants with severe G-INJ is associated with lower infectious morbidity and mortality. All infants admitted to the regional NICU from October 1991 to February 2003 were included in this prospective prevalence investigation of G-INJ and infections. Non-viable (<23 week gestational age) infants, infants with congenital anomalies, and those who developed NEC after SIP were excluded. Standard definitions of National Centers for Disease Control and Prevention were used for different categories of infections. Episodes of infections were classified as concurrent or non-concurrent (post G-INJ) based upon their timing in association with G-INJ. Infants with G-INJ associated with Bell stage II or higher NEC or with SIP were further stratified by DEB into two subgroups. A previously described 7-point clinical score was used to divide G-INJ into mild (0–2), moderate (3–5), and severe (6–7) categories. Surgical outcomes were determined by using χ2 and logistic regression analyses. Data are expressed as mean ± SD or as odds ratio (OR) with 95% confidence intervals (CI); P<0.05 was considered significant. Of all 5,481 infants, 954 (17.4%) developed 1,734 episodes of infections. Prevalence of G-INJ was 4% (n=222); of these, 33% (n=73) underwent DEB. Infants with G-INJ had lower mean birth weight (1,414±766 vs. 2,153±104 g; P<0.0001) and lower mean gestational age (29.6±4.2 vs. 32.9±4.8 weeks; P<0.0001) than their peers (n=5,259). Controlling for birth weight and gestational age, odds for non-concurrent blood stream infections (BSIs) in G-INJ infants were higher (OR 13.98, CI 10.289–19.01, P<0.0001) than the remaining population without G-INJ. Forty-four percent of all episodes of fungemia, 32% of all episodes of BSIs occurred in G-INJ infants (P<0.0001). Within the G-INJ group, there were no demographic differences between the DEB and non-DEB infants. Controlling for severity of G-INJ, odds for non-concurrent BSIs (OR 3.45, CI 1.04–11.36, P<0.05) and for mortality (OR 3.35, CI 1–10, P<0.05) among non-DEB infants were higher than in DEB infants. Infants with G-INJ suffered from a disproportionate number of all blood-stream infections in our intensive care nursery. Infants with severe G-INJ whose management includes DEB are more likely to survive and to incur less infectious morbidity.

Keywords

Necrotizing enterocolitis Intestinal perforation Neonatal gut injury Surgical debridement Infection rate Neonates Intensive care nursery Outcome 

References

  1. 1.
    Kliegman RM (1998) Pathophysiology and epidemiology of necrotizing enterocolitis. In: Polin RA, Fox WW (eds) Fetal and neonatal physiology. Saunders, Philadelphia, pp 1425–1432Google Scholar
  2. 2.
    Hsueh W, Caplan MS, Qu XW, Tan XD, De Plaen IG, Gonzalez-Crussi F (2002) Neonatal necrotizing enterocolitis: clinical considerations and pathogenetic concepts. Pediatr Dev Pathol 6:6–23CrossRefPubMedGoogle Scholar
  3. 3.
    Sharma R, Tepas JJ III, Mollitt DL, Pieper P, Wludyka P (2004) Surgical management of bowel perforation in very-low-birth-weight infants (< 1200 g). J Pediatr Surg 39:190–194CrossRefPubMedGoogle Scholar
  4. 4.
    Sharma R, Garrison RD, Tepas JJ III, Mollitt DL, Pieper P, Hudak ML, Bradshaw JA, Stevens G, Premachandra BR (2004) Rotavirus-associated necrotizing enterocolitis: An insight into a potentially preventable disease? J Pediatr Surg 39:453–457CrossRefPubMedGoogle Scholar
  5. 5.
    Kaufman D, Fairchild KD (2004) Clinical Microbiology of bacterial and fungal sepsis in very-low-birth-weight infants. Clin Microbiol Rev 17:638–680CrossRefPubMedGoogle Scholar
  6. 6.
    Sonntag J, Wagner MH, Waldschmidt J, Wit J, Obladen M (1998) Multisystem organ failure and capillary leak syndrome in severe necrotizing enterocolitis of very low birth weight infants. J Pediatr Surg 33:481–484CrossRefPubMedGoogle Scholar
  7. 7.
    Bell MJ, Ternberg JL, Feign RD (1978) Neonatal necrotizing enterocolitis: Therapeutic decisions based upon clinical staging. Ann Surg 187:1–7PubMedCrossRefGoogle Scholar
  8. 8.
    Bisquera JA, Cooper TR, Berseth CL (2002) Impact of necrotizing enterocolitis on length of stay and hospital charges in very low birth weight infants. Pediatrics 109:423–428CrossRefPubMedGoogle Scholar
  9. 9.
    Horan TC, Emori TG (1997) Definitions of key terms used in the National Nosocomial Infections Surveillance (NNIS) system. Am J Infect Control 25:112–116CrossRefPubMedGoogle Scholar
  10. 10.
    Uauy RD, Fanaroff AA, Korones SB, Phillips EA, Phillips JB, Wright L (1991) Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical correlates. J Pediatr 119:630–638PubMedCrossRefGoogle Scholar
  11. 11.
    Willoughby RE Jr, Pickering LK (1994) Necrotizing enterocolitis and infection. Clin Perinatol 21:307–315PubMedGoogle Scholar
  12. 12.
    Cordero L, Rau R, Taylor D, Ayers LW (2004) Enteric gram-negative bacilli blood stream infections: 17 years’ experience in a neonatal intensive care unit. Am J Infect Control 32:189–195CrossRefPubMedGoogle Scholar
  13. 13.
    Hallstrom M, Eerola E, Vuento R, Janas M, Tammela O (2004) Effects of mode of delivery and necrotizing enterocolitis on the intestinal micro flora in preterm infants. Eur J Clin Microbiol Infect Dis 23:463–470PubMedCrossRefGoogle Scholar
  14. 14.
    Stoll BJ, Hansen N, Fanaroff AA, Wright LL et al (2002) Late-onset sepsis in very low birth weight neonates: the experience of the NICHD. Neonatol Res Network Pediatr 11:285–291Google Scholar
  15. 15.
    Rowe MI, Reblock KK, Kurkchubasche AG et al. (1994) Necrotizing enterocolitis in the extremely low birth weight infant. J Pediatr Surg 29:987–991CrossRefPubMedGoogle Scholar
  16. 16.
    Banieghbal B, Davies MR (2004) Damage control laparotomy for generalized necrotizing enterocolitis. World J Surg 28:183–186CrossRefPubMedGoogle Scholar
  17. 17.
    Stuart SK, Gabriel EG, Thomas M (2003) Fishbein Parenteral nutrition associated liver disease. Semin Neonatol 8:375–381CrossRefPubMedGoogle Scholar
  18. 18.
    Gollin G, Abarbanell A, Baerg JE (2003) Peritoneal drainage as definitive management of intestinal perforation in extremely low-birth-weight infants. J Pediatr Surg 38:1814–1817CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Renu Sharma
    • 1
    Email author
  • Joseph J. TepasIII
    • 1
  • Mark L. Hudak
    • 1
  • Pam Pieper
    • 1
  • Ru-Jeng Teng
    • 1
  • Savithri Raja
    • 1
  • Monica Sharma
    • 1
  1. 1.Division of Neonatology, Departments of PediatricsUniversity of Florida at JacksonvilleJacksonvilleUSA

Personalised recommendations