Abstract
Objective:
New biopharmaceuticals hold promise for preventing or treating necrotizing enterocolitis. However, it is unclear whether any such biopharmaceutical that requires enteral administration could be administered using an ‘early-treatment’ paradigm. This study was undertaken to assess this issue based on data from every case of Bell stage III NEC cared for during the past 7 years at Intermountain Healthcare.
Study Design:
Patients with Bell stage III NEC were identified from electronic medical record repositories and the diagnosis was validated using operative reports. Electronic and paper records of each patient were then used to identify potential clinical and laboratory antecedents occurring within the 48 h period preceding the diagnosis of NEC.
Result:
One hundred eighteen patients had Stage III NEC. The earliest recognized antecedents were nonspecific for NEC (apnea/bradycardia, skin mottling and irritability). These were recorded at 2.8±2.1, 4.5±3.1 and 5.4±3.7 (mean±s.d.) hours, respectively, before NEC was diagnosed. The most commonly identified gastrointestinal antecedents were blood in the stools, increased abdominal girth and elevated pre-feeding gastric residuals or emesis. These were identified 2.0±1.9, 2.8±3.1 and 4.9±4.0 h before NEC was recognized. Thirty-eight percent had a blood transfusion (18±12 h) preceding the NEC. Tachycardia, tachypnea, hypotension and diarrhea were rarely identified as antecedents and no consistent laboratory antecedents were discovered.
Conclusion:
We judge that an ‘early treatment of NEC’ paradigm testing any pharmacological agent that must be administered enterally is not feasible. The first recognized antecedents of Bell stage III NEC are nonspecific for gastrointestinal pathology and insufficient time exists for dosing between the first gastrointestinal signs and placement of the gastric decompression tube.
Similar content being viewed by others
References
Grave GD, Nelson SA, Walker WA, Moss RL, Dvorak B, Hamilton FA et al. New therapies and preventive approaches for necrotizing enterocolitis: Report of a research planning workshop. Pediatr Res 2007; 62: 510–514.
Neu J . Neonatal necrotizing enterocolitis: an update. Acta Paediatr Suppl 2005; 94: 100–105.
Moss RL, Dimmitt RA, Barnhart DC, Sylvester KG, Brown RL, Powell DM et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med 2006; 354: 2225–2234.
Moss RL, Kalish LA, Duggan C, Johnston P Brandt ML, Dunn JC et al. Clinical parameters do not adequately predict outcome in necrotizing enterocolitis: a multi-institutional study. J Perinatol 2008; 28: 665–674.
Feng J, El-Assal ON, Besner GE . Heparin-binding epidermal growth factor-like growth factor decreases the incidence of necrotizing enterocolitis in neonatal rats. J Pediatr Surg 2006; 41: 144–149.
El-Assal ON, Paddock H, Marquez A, Besner GE . Heparin-binding epidermal growth factor-like growth factor gene disruption is associated with delayed intestinal restitution, impaired angiogenesis, and poor survival after intestinal ischemia in mice. J Pediatr Surg 2008; 43 (6): 1182–1890.
Nair RR, Warner BB, Warner BW . Role of epidermal growth factor and other growth factors in the prevention of necrotizing enterocolitis. Semin Perinatol 2008; 32 (2): 107–113.
Halpern MD, Holubec H, Clark JA, Saunders TA, Williams CS, Dvorak K, Dvorak B . Epidermal growth factor reduces hepatic sequelae in experimental necrotizing enterocolitis. Biol Neonate 2006; 89 (4): 227–235.
Lau CY, Cardinali M, Sato PA, Fix A, Flores J . Broadening inclusion of vulnerable populations in HIV vaccine trials. Expert Rev Vaccines 2008; 7 (2): 259–268.
Attridge JT, Clark R, Walker MW, Gordon PV . New insights into spontaneous intestinal perforation using a national data set: (1) SIP is associated with early indomethacin exposure. J Perinatol 2006; 26: 93–99.
Gordon PV, Swanson JR, Attridge JT, Clark R . Emerging trends in acquired neonatal intestinal disease: is it time to abandon Bell's criteria? J Perinatol 2007; 27: 661–671.
Baer VL, Lambert DK, Schmutz N, Henry E, Stoddard RA, Miner C et al. Adherence to NICU transfusion guidelines: data from a multihospital healthcare system. J Perinatol 2008; 28 (7): 492–497.
Guthrie SO, Gordon PV, Thomas V, Thorp JA, Peabody J, Clark RH . Necrotizing enterocolitis among neonates in the United States. J Perinatol 2003; 23: 278–285.
Wiedmeier SE, Henry E, Baer VL, Stoddard RA, Eggert LD, Lambert DK et al. Center differences in NEC within one healthcare system may depend on feeding protocol. Am J Perinatol 2008; 25: 5–12.
Lambert DK, Christensen RD, Henry E, Besner GE, Baer VL, Wiedmeier SE et al. Necrotizing enterocolitis in term neonates: data from a multihospital healthcare system. J Perinatol 2007; 27: 437–443.
Christensen RD, Lambert DK, Schmutz N, Stoddard RA . Fatal bowel necrosis in two polycythemic term neonates. Fetal Pediatr Pathol 2008; 27 (1): 41–44.
Stout G, Lambert DK, Baer VL, Gordon PV, Henry E, Wiedmeier SE et al. Necrotizing enterocolitis during the first week of life: a multicentered case-control and cohort comparison study. J Perinatol 2008; 28 (8): 556–560.
Kilic N, Büyükünal C, Dervisoglu S, Erdil TY, Altiok E . Maternal cocaine abuse resulting in necrotizing enterocolitis. An experimental study in a rat model. II. Results of perfusion studies. Pediatr Surg Int 2000; 16 (3): 176–178.
Hohlagschwandtner M, Husslein P, Klebermass K, Weninger M, Nardi A, Langer M . Perinatal mortality and morbidity. Comparison between maternal transport, neonatal transport and inpatient antenatal treatment. Arch Gynecol Obstet 2001; 265 (3): 113–118.
Mally P, Golombek SG, Mishra R, Nigam S, Mohandas K, Depalhma H et al. Association of necrotizing enterocolitis with elective packed red blood cell transfusions in stable, growing, premature neonates. Am J Perinatol 2006; 23 (8): 451–458.
Kenton AB, Hegemier S, Smith EO, O'Donovan DJ, Brandt ML, Cass DL et al. Platelet transfusions in infants with necrotizing enterocolitis do not lower mortality but may increase morbidity. J Perinatol 2005; 25 (3): 173–177.
Acknowledgements
Supported in part by a grant from Trillium Therapeutics Inc., Toronto, Canada.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Christensen, R., Wiedmeier, S., Baer, V. et al. Antecedents of Bell stage III necrotizing enterocolitis. J Perinatol 30, 54–57 (2010). https://doi.org/10.1038/jp.2009.93
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jp.2009.93
- Springer Nature America, Inc.
Keywords
This article is cited by
-
A murine neonatal model of necrotizing enterocolitis caused by anemia and red blood cell transfusions
Nature Communications (2019)
-
Does red blood cell irradiation and/or anemia trigger intestinal injury in premature infants with birth weight ≤ 1250 g? An observational birth cohort study
BMC Pediatrics (2018)
-
Pathophysiology and Current Management of Necrotizing Enterocolitis
The Indian Journal of Pediatrics (2014)
-
Packed red blood cell transfusion is an independent risk factor for necrotizing enterocolitis in premature infants
Journal of Perinatology (2013)
-
Association of necrotizing enterocolitis with anemia and packed red blood cell transfusions in preterm infants
Journal of Perinatology (2011)