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.


Contact

Deborah Van Dyke
4th year student (visiting from U of A)
E: dvandyke@uoguelph.ca


Andrea Buchholz, PhD, RD
Faculty Advisor
Dept of Family Relations and Applied Nutrition
University of Guelph
E: abuchhol@uoguelph.ca



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Georgia won’t have a stated goal of making it to the College Football Playoff this year. It will talk about winning the SEC East, something it has done the past two years and is favored to do so again in 2019. Should the Bulldogs get to Atlanta, it’ll make winning the SEC a goal as well. Winning the SEC has gotten a team into the College Football Playoff in every season.

Unknown said...

How To Watch Official Live Rugby Online StreamingStreaming Online.In this modern era with the help of newer technologies, it has become very easy to enjoy Wales vs Fiji Live on any gadgets. Fans can watch Wales vs Fiji Live stream online on their Pad, Mac, PC, Laptop or any Android device. They can watch and listen to the commentaries any time, any place, anywhere in the world. We will be engineered to offer the highest quality live streaming services at the best prices. Fans only have to pay a little amount to enjoy Wales vs Fiji Game live streaming actions. The best part is you get access for an entire year, so you’ll be watching and following your favorite team or competition throughout the entire season.Rugby World Cup 2019 will air on September 2019. You have not enough time to get ready. Your favorite Wales vs Fiji match also here under this Rugby World Cup 2019. As a die-hard fan of rugby, you need to know some essential element about this game. Because you are willing to enjoy the match. You should know about this match. Let’s know some important thing about this match.It is acknowledged to all that official channels will live broadcast the most expected event Like Rugby World Cup 2019. You can also watch the event on social networking sites such as Facebook, Twitter, Reddit, Instagram, YouTube and so on. Lots of big events like Rugby, Golf, NFL, NCAA, etc are streamed on these social sites. As other great events, you can also enjoy Wales vs Fiji live. Here are some instructions for you about the Event on social streaming.
Wales vs Fiji Rugby Date and Time,The match between Wales vs Fiji will air at 10.45 AM Wednesday, October 9, 2019. The match will one of the best match on the Rugby World Cup 2019. So, Enjoy your match as you want.
Wales vs Fiji Rugby Venue,Wales vs Fiji will take place in Oita Stadium. Set inside shocking parkland simply outside Oita City, Oita Arena will have five epic Rugby World Cup 2019 matches including the quarterfinals of Pools An and B. As the biggest Rugby World Cup 2019 scene on the southern island of Kyushu, Oita will really shake as rugby fans from all through Japan and over the world meet up to watch probably the greatest names in the realm of rugby fight it out on their mission to raise the Webb Ellis Cup and be delegated rugby title holders.
Final Note,From Beginning to finish you will get a lot of essential information about Wales vs Fiji match which will air on after a few days later in Rugby World Cup 2019. We have tried to give you the information which is very needed. Some of those are two teams about 2019, Date and Time, tickets, online channel, etc. So, you can enjoy your favorite match Wales vs Fiji Live Streaming online. For more more information keep visiting here as you can.
Rugby world cup 2019 is knocking at the door. There is not enough time in your hand to getting ready. Because September 20 it will take place in Japan. It is the 9th World Cup in Rugby history. But, it is one of the most expecting Events in 2019. Don’t miss to enjoy your favorite team game. All game is very important for every team. In this case, you will get more pleasure than another rugby event. Now enjoy your favorite Rugby World Cup 2019 As you can.



juventus-vs-milan said...

RWC 2019 is an upcoming rugby event. It will take place in Japan. So, every fan can enjoy it by sitting at the stadium. For this reason, they have to find some online channel. Because it is very hard to find any channel to enjoy the event. But there are many online channels who will telecast the event live.
Today is another step in the progress towards the Rugby World Cup. We have taken the decision to go early because of what we learned from previous campaigns. We want the squad to know early and now we can get on and be the best prepared England side there has ever been, ready to win the World Cup.”
https://englandvstongarwc2019.info/

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