Wednesday, May 5, 2010

Necrotizing Enterocolitis and the Preterm Infant

Necrotizing Enterocolitis (NEC) is an inflammatory bowel disease affecting three to ten percent of neonates in intensive care units (ICU) (Bisquera et al., 2002: Guthrie et al., 2003) and results in necrosis of the intestinal tissue and possible perforation of the bowel (Kafetzis et al., 2003; MedlinePlus, 2009). NEC predominantly affects low birth weight (LBW) and very low birth weight (VLBW) neonates (Kafetzis et al., 2003; Martin et al., 2008) and plays a significant role in the morbidity and mortality (rates reported between 13%-25%) of these infants (Guner et al., 2009; Henry et al., 2009; Lambert et al., 2007). A Canadian survey of 18,234 infants, in 17 neonatal intensive care units (NICU), reported the incidence of NEC among VLBW infants ( less than 1500g ) as 6.6 percent (Sankaran et al., 2004).

The etiology of NEC (with severity classified on a scale of I (mild) to III (severe, including GI hemorrhage and septic shock) (Bell et al., 1978)) is multifactorial. Many pathogenic factors play a role, including, immaturity and ischemia of the gastrointestinal (GI) tract, and changes in commensal gut microflora (normal, indigenous bacteria) accompanied by increases in pathogenic bacteria as well intestinal inflammation (Hsueh et al., 2003; Panigrahi, 2006; Thompson et al., 2008). Treatment includes medically and surgically invasive procedures such as intravenous fluids, orogastric and peritoneal drainage and laparotomy (Panigrahi, 2006; Thompson et al., 2008). It is therefore important to prevent and manage the disease so that this already vulnerable population is not placed under even greater risk for complications.

Are There Alternative Treatments?

Reviews of the use of probiotics (defined as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host” (FAO/WHO, 2001, pg. 5)) for the treatment of acute and antibiotic associated diarrhea and atopic dermatitis in infants have suggested that for these conditions, probiotics are tolerated well, and are beneficial and safe for infants (Kullen et al., 2005; Saavedra, 2007).

Although not as extensive, research regarding administration of prophylactic probiotics to VLBW neonates shows a decrease in the incidence a nd severity of NEC. The rationale for supplementation of probiotics for prevention and management of NEC in infants is that the bacteria will restore microbial balance to the immature gut by competing with pathogens, thereby improving the gut barrier and decreasing inflammatory responses (Costalos et al., 2003; Cucchiara et al., 2002; Martin et al., 2008).

Relevance to Practice

Clinical trials conducted in NICUs using various probiotics are promising. Dani et al. (2002) conducted a prospective, multi-centre, double-blind, randomized study of VLBW preterm infants. The probiotic group (PG) received a dose of 6 x 109 colony-forming units (CFU) of Lactobacillus GG each day (in pasteurized breastmilk or infant formula) until discharge. The incidence of NEC was lower in the PG (1.4 compared to 2.8 percent) but not significant. Bin-Nun et al. (2005) conducted a blinded randomized trial using a different probiotic supplement (ABC Dophilus: Bifidobacteria infantis, Streptococcus thermophilus and Bifidobacteria bifidus at a dose of 1.05 x 109 CFU per day added to breastmilk or enteral formula). Incidence of NEC in the PG was significantly lower (4 percent) than the placebo group (16.4 percent; p=0.03), as was the severity. Two randomized controlled trials, using Infloran (Lactobacillus acidophilus and Bifidobacterium infantis; dosage of 125 mg/kg per dose of 109 CFU twice daily added to breastmilk or formula) on VLBW infants, demonstrated a significantly lower incidence and severity of NEC in the PG (Lin et al., 2005; Lin et al., 2008). Lastly, a historic control group was compared to a newborn PG (treated with Lactobacillus acidophilus and Bifidobacterium infantis, 250 x 106 CFU, in sterilized water or 5 percent dextrose, via orogastric tube or drops into the mouth) admitted to the ICU during one year. Although the dose was smaller than other studies, this trial demonstrated a significant reduction in NEC (Hoyos, 1999). No significant adverse reactions were reported in these studies.

Probiotics are potentially beneficial in preventing NEC in neonates. However, evidence is lacking to recommend the most beneficial probiotics, the best time to initiate prophylaxis, the optimal dose, or the duration of treatment. A predictive model using United States NEC statistics estimated an increase length of stay (where surgical NEC infants exceeded controls by 60 days and medical NEC infants exceeded controls by 22 days), and an additional $6.5 million in hospital charges per year, or $216,666 per NEC survivor (Bisquera et al., 2002). As technology and health care practices improve, survival of VLBW neonates will increase possibly increasing the incidence of NEC. This should be taken as a call to action. The ‘cost’ of NEC on the neonatal community (financially for the health care system, and emotionally for parents aware of the bleak statistics) is arguably far greater than the ‘price’ of using health care dollars to research best practices for the use of probiotics for the prevention of NEC in neonates.

REFERENCES available from Andrea Buchholz.


Deborah Van Dyke
4th year student (visiting from U of A)

Andrea Buchholz, PhD, RD
Faculty Advisor
Dept of Family Relations and Applied Nutrition
University of Guelph


birkin bag said...

Thanks for sharing so significative article with us. Wonder Know is a comprehensive website that provides all kinds of articles. Just come and have fun!

alex hren said...

And what about you? Your reasons for being here are:
1) To criticize others
2) To make unsubstantiated claims
3) To trade insults
4) To write crap
5) To show off that you are the most talented writer in the world. Do you possess a PhD in English Language? No.
Do they really help anyone? No.

craftywriter Jun 25, 11, 11:10PM | #12
Twig, never argue with a fool (pheelyks), he will lower you to his level, and then beat you with experience.

craftywriter Jun 25, 11, 11:34PM | #13

pheelyks Jun 26, 11, 09:55AM | #14
I am a writer with integrity, and writes for 20 private clients.

Wow. 20. They must all be really pleased at the barely passing grades you are able to earn with those ESL skills.
1) To criticize others

Only when they deserve criticism. This site is devoted to exposing scam writers/companies, after all.
2) To make unsubstantiated claims

Not at all. i substantiate my claims as much as possible, and clearly acknowledge when I am voicing suspicions rather than facts.
3) To trade insults

I'd rather not, and actually "insult" other posters a lot less than they attempt to insult me. The fact that you take criticism of your language skills as an insult does not mean that it was my intent to insult; it is more evidence of your emotional state than of mine.
4) To write crap

Essay jedii said...

Very good post. Made me realize I was totally wrong about this issue. I figure that one learns something new everyday. Mrs Right learned her lesson! Nice, informative website by the way. Want also to share with u what I found

Denisa Cretu said...

This is a really super post. Must admit that you are amid the best writer I have read. I appreciate your making the effort to discuss this class of article.

yuvikhan said...

good Connect iOS machine to your Apple computer Program, guide from kodiforiphone this two times clicking on this. As well choose Kodi iPhone without Jailbreak nice.

ershovayuli said...

good Apple pc personal computers. I rarely desire to talk about go to xenderdownloads top or notebook computer computer system. I believe, Xender APK Download nice.

robertgreene said...

good Press on the company logo to start the app. visit vootdownloadapp Voot App offers the same functionalities as the Hotstar, Voot Download Free nice.

lewismichael said...

good delete unnecessary apps, game titles, data, marketing and anything else, Showbox APK that does indeed certainly not indicate that it can be not really nice.

flip diving said...

I really wanted to send a small word to say thanks to you for the fantastic points you are writing on this site.

богдан ян said...

Bonjour et merci pour votre contribution,, puis-je vous soumettre une question : me permettez-vous de faire un lien par mail vers cet article ? Merci pour tout.
thanks for your sharing, I appreciate this. keep up the good work

Linda Nabors said...

Xmod is very easy and handy for the people using Android mobile phone.

meyerangel said...

Great According to Trello, where Slack published Slack for Windows Download as Desktop App Slack stated a person obtained unauthorized Fine.

HannahAMueller said...

good An additional conversation software program with video clip FaceTime for Android Download [Latest Update] You can have video clip conversation or real-time text conversation. best.

HannahAMueller said...

good calling functions. The complimentary Yahoo Messenger application. FaceTime APK Data Latency is one front where Hangouts has a side over Facetime. best.

audreybphillips said...

Great also any kind of stuff from all internet sites. Vidmate APK Download Vidmate application on your smart device or PC besides its free Fine.

bettycyoung said...

Great and also Spotify, done in one place. Some attachments ikodidownload Dual click 'Add Resource' to include a brand-new database Fine.

bettycyoung said...

Great With the assistance of these basic actions, XHubs is a terrific Android Applications for video clip download Fine.

cathrynzbrown said...

Great installed on your Mac, we can get started. Kodi Chromecast Return to the primary screen and also you'll see a message Fine.

Globeservations said...

Now I would like to also add that since Valentine's Day is coming, if you are looking for the right words for your loved one, then check out these Happy Valentine's Day and Valentine messages.

cathrynzbrown said...

awesome frequently it really feels a little restricted, however additionally secure. Snapchat Login accustomed to utilizing when you talk with friends nice.

sarahofalk said...

good While the Amazon Appstore does have most of the apps one might desire, an app to authorize out from your Google account. nice.

stefaniekwoodard said...

good This is yet one more popular cult application tubidy mp3 as a result a user can conveniently download and install, best.

happy wheels said...

I think this is one of the most significant information for me. And i’m glad reading your article. Thank for sharing!

happy wheels demo said...

I think this is an informative post and it is very useful and knowledgeable. I have a sheet all your articles. Thanks for this best post.

MOHAN SAI said...

Existing without the answers to the difficulties you’ve sorted out through this guide is a critical case, as well as the kind which could have badly affected my entire career if I had not discovered your website.

Nova Launcher download

Casper nirvana

Peel smart remote watchon

ElizabethMartin said...

applications that are readily available for Android System using Appvn Download such as English and Vietnam. The customers can choose

SandraRoper said...

applications available for enjoying TELEVISION on android, you tv player download download You TELEVISION player APK, ways to install as.

KellieWilliams said...

Browse for Terrarium TV in the search bar. Terrarium TV APK appreciate the services provided by the application.

GladysHardeman said...

level app to the similarity Dubsmash. This app enables lip App The application was introduced in the year 2014.

Ann Lily said...

Hello! I’m a Ann, I would like to challenge the whole world with the kind of games follows:
First, word cookies game is a very fun and exciting word puzzle game, it makes you keep playing for FREE! The aim of the game is to find all hidden words. With this game you can easily improve your vocabulary, concentration and spelling skills.
Second, hotmail email login is an free e-mail service provided to Internet users by the giant Microsoft. If you are a new user of this service and don’t exactly know how the Hotmail sign in process works, you can follow the steps below to log in to Hotmail account.
And finally, hotmail account login is one of the popular email service and the most commonly used today. Now, let’s guide you through on how to Sign in to Hotmail, follow the steps below to log in to your Hotmail account.

Anonymous said...

Best text free apps

Best free video editing Software

Best Caller id Apps

GladysHardeman said...

Install the application from unknown resources, Fildo songs apply for free. You could additionally download.

jimmiesdchmit said...

battery with the clamps and it offers your lorry a jumpstart. Ann S. Winer push to see if it is fully billed, partly charged, or requires charging.

shengda xu said...

coach purses
kate spade bags
michael kors outlet clearance
dodgers jerseys
ray ban sunglasses discount
mlb jerseys
beats wireless headphones
patriots jerseys
louboutin shoes
hollister kids

MOHAN SAI said...

Thanks a lot very much for the high quality and results-oriented help. I won’t think twice to endorse your blog post to anybody who wants and needs support about this area.

download fake gps

Bleach brave souls mod said...

We the company founded in 1977 and started franchising since 1992, United Check Cashing and landed as a check casher industry in USA. We are covering most of the cities and still giving you the best services within very short period with top notch satisfaction. We can trace us 24/7 and you are always welcome.

Johnson Charles said...

After a very successful first four seasons, the makers of Vikings are finally coming up with the fifth season. It will have
some starcast changes and hopefully it is going to be even more exciting. You can check out the release date and the cast
changes as well if you want Vikings Season 5 Trailer said...

Utilize payday credits precisely. Perused the payday credit organization's agreement deliberately, before marking and get some information about all expenses and loan fees, how they work and in what conditions they apply.

Payday Loans Chicago said...

Particularly in cruel financial circumstances, it's basic for customary people to need money. Be that as it may, if your credit is beneath normal, getting an advance might be troublesome. In such a case, you might need to consider a payday credit.

Auto Title Loans Chicago said...

Pretty much everybody has encountered a budgetary crisis. Regardless of whether that implies a costly substitution, a sudden bill, or a required up front installment, these crises could cost a ton of cash that you simply don't have. When you're in a circumstance where you require a lot of money quick, you may end up noticeably baffled and in a rush in case you don't know where to look.

my wifi router 3.0 said...

nice post i like it carry in your work

Akshi Sharma said...

The Fildo application user interface is really Fildo App Open up the Fildo Android documents with Bluestacks.
Fildo 2.1.5

Asif Malik said...

I am in fact happy to glance at this web site posts which includes lots of useful data, thanks for providing these kinds of information.
driver navigator license key

ManyCam Crack

bandicam crack

X-Mirage Key

Download Serial Key

Akshi Sharma said...

good offline setting: Tap the major menu button, after that toggle Fildo Music App chance that you currently recognize how to download nice.
Fildo 2.1.5

KellieWilliams said...

cabinet and there you could see the 'Google Settings' application. This android emulator helps us run Android OS on our PC.

Akshi Sharma said...

Interesting Post
Watch us open online

Akshi Sharma said...

Click here to get

Akshi Sharma said...

nice click here..
Watch Wimbledon online

driving route map said...

I like it when folks come together and share thoughts. Great blog, continue the good work! driving route map