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Gangrenic Guts and Hospital Grub
"Necrotizing Enterocolitis was exclusively among already admitted
neonates"
Necrotizing enterocolitis in term neonates: data from a multihospital
health-care system.
Objective:
In the past 5(1/2) years, 30 term or near-term neonates in the
Intermountain Healthcare system developed necrotizing enterocolitis
(NEC) Bell's stage >/=II. We sought to identify possible explanations
for why these patients developed NEC, by comparing them with 5847
others that did not develop NEC, from the same hospitals and of the
same gestational ages, cared for during the same 5(1/2)-year period.
Study design:
Data were collected from neonates admitted to any of the Intermountain
Healthcare NICUs with a birth date from 1 January 2001 to 30 June
2006, and a gestational age >36 weeks. A variety of patient features
and feeding practices were compared between those that did vs did not
develop NEC.
Result:
Forty-one neonates >36 weeks gestation were listed in the discharge
records as having NEC of Bell's stage II or higher. However, on review
of these 41 medical records, 11 were seen to have had NEC of Bell's
stage I, whereas the remaining 30 had radiographs and clinical courses
indicative of Bell's stage >/=II. Those 30 formed the basis of this
study. Twenty-eight of the 30 developed NEC after having been admitted
to an NICU for some other reason; the other two developed NEC at home,
within 2 days of being discharged from an NICU. The 30 that developed
NEC were more likely than the 5847 that did not develop NEC, to have
congenital heart disease (P=0.000), polycythemia (P=0.002), early-
onset bacterial sepsis (P=0.004) or hypotension (P=0.017). All 30
received enteral feedings before NEC developed; 29 were fed either
artificial formula or a mixture of formula and breast milk. The one
that was exclusively fed human milk was fed human milk with added
fortifier (24 cal/oz). The 30 that developed NEC were more likely to
be fed formula exclusively (P=0.000). Seven of the 30 had a laparotomy
for NEC; two of the seven had total bowel necrosis and support was
withdrawn. The other five had perforations and bowel resections. The
mortality rate was 13% (4/30).
Conclusion:
In our series, NEC among term or near-term neonates was exclusively a
complication developing among patients already admitted to a NICU for
some other reason. We speculate that the combination of reduced
mesenteric perfusion and feeding with artificial formula were factors
predisposing them to develop NEC.
Journal of Perinatology (2007) 27, 437-443; doi:10.1038/sj.jp.
7211738;
published online 29 March 2007.
Keywords: developed, formula, neonates, develop, stage, exclusively,
admitted, were more, more likely, artificial formula, human milk, that
developed, other reason, term neonates, intermountain healthcare, some
other, near term
Authored by Lambert DK, Christensen RD, Henry E, Besner GE, Baer VL,
Wiedmeier SE, Stoddard RA, Miner CA, Burnett J. [1] 1Intermountain
Health Care, Ogden, UT, USA [2] 2Department of Neonatology, McKay-Dee
Hospital Center, Ogden, UT, USA.
Published in J Perinatol. 2007 Jul;27(7):437-43. Epub 2007 Mar 29. The
full report is available online >> a subscription to the periodical may
be required.
Who loves ya.
Tom
Jesus Was A Vegetarian!
* jesuswasavegetarian.7h . com
Man Is A Herbivore!
* tinyurl . com /a3cc3
DEAD PEOPLE WALKING
* tinyurl . com /zk9fk
neonates"
Necrotizing enterocolitis in term neonates: data from a multihospital
health-care system.
Objective:
In the past 5(1/2) years, 30 term or near-term neonates in the
Intermountain Healthcare system developed necrotizing enterocolitis
(NEC) Bell's stage >/=II. We sought to identify possible explanations
for why these patients developed NEC, by comparing them with 5847
others that did not develop NEC, from the same hospitals and of the
same gestational ages, cared for during the same 5(1/2)-year period.
Study design:
Data were collected from neonates admitted to any of the Intermountain
Healthcare NICUs with a birth date from 1 January 2001 to 30 June
2006, and a gestational age >36 weeks. A variety of patient features
and feeding practices were compared between those that did vs did not
develop NEC.
Result:
Forty-one neonates >36 weeks gestation were listed in the discharge
records as having NEC of Bell's stage II or higher. However, on review
of these 41 medical records, 11 were seen to have had NEC of Bell's
stage I, whereas the remaining 30 had radiographs and clinical courses
indicative of Bell's stage >/=II. Those 30 formed the basis of this
study. Twenty-eight of the 30 developed NEC after having been admitted
to an NICU for some other reason; the other two developed NEC at home,
within 2 days of being discharged from an NICU. The 30 that developed
NEC were more likely than the 5847 that did not develop NEC, to have
congenital heart disease (P=0.000), polycythemia (P=0.002), early-
onset bacterial sepsis (P=0.004) or hypotension (P=0.017). All 30
received enteral feedings before NEC developed; 29 were fed either
artificial formula or a mixture of formula and breast milk. The one
that was exclusively fed human milk was fed human milk with added
fortifier (24 cal/oz). The 30 that developed NEC were more likely to
be fed formula exclusively (P=0.000). Seven of the 30 had a laparotomy
for NEC; two of the seven had total bowel necrosis and support was
withdrawn. The other five had perforations and bowel resections. The
mortality rate was 13% (4/30).
Conclusion:
In our series, NEC among term or near-term neonates was exclusively a
complication developing among patients already admitted to a NICU for
some other reason. We speculate that the combination of reduced
mesenteric perfusion and feeding with artificial formula were factors
predisposing them to develop NEC.
Journal of Perinatology (2007) 27, 437-443; doi:10.1038/sj.jp.
7211738;
published online 29 March 2007.
Keywords: developed, formula, neonates, develop, stage, exclusively,
admitted, were more, more likely, artificial formula, human milk, that
developed, other reason, term neonates, intermountain healthcare, some
other, near term
Authored by Lambert DK, Christensen RD, Henry E, Besner GE, Baer VL,
Wiedmeier SE, Stoddard RA, Miner CA, Burnett J. [1] 1Intermountain
Health Care, Ogden, UT, USA [2] 2Department of Neonatology, McKay-Dee
Hospital Center, Ogden, UT, USA.
Published in J Perinatol. 2007 Jul;27(7):437-43. Epub 2007 Mar 29. The
full report is available online >> a subscription to the periodical may
be required.
Who loves ya.
Tom
Jesus Was A Vegetarian!
* jesuswasavegetarian.7h . com
Man Is A Herbivore!
* tinyurl . com /a3cc3
DEAD PEOPLE WALKING
* tinyurl . com /zk9fk
