Acta paediatrica ; Vol. 83 Supplement 396
[1st ed.] 100 s. : fot., obr., tab., grafy ; 28 cm
- MeSH
- Child MeSH
- Enterocolitis MeSH
- Infant MeSH
- Infant, Newborn, Diseases MeSH
- Infant, Low Birth Weight MeSH
- Check Tag
- Child MeSH
- Infant MeSH
- Publication type
- Congress MeSH
- Conspectus
- Lékařské vědy. Lékařství
- NML Fields
- pediatrie
- gastroenterologie
Cíl: Zhodnocení součastných možností léčby nekrotizující enterokolitidy u novorozenců s porodní hmotností nižší než 1000 g. Metoda a materiál: Retrospektivní studie klinických a patologických dat u 19 novorozenců s porodní hmotností pod 1000 g léčených pro nekrotizující enterokolitidu (NEC) na pracovišti autorů v období 1999-2003. Do souboru byli zařazeni pouze novorozenci s druhým a třetím stupněm NEC podle Bella. Výsledky: V souboru bylo 19 novorozenců porozených v průměru ve 26. gestačním týdnu (v rozmezí 23-31) a s průměrnou porodní hmotností 711 gramů (v rozmezí 460-980 g). NEC vznikla v průměru 18. den po porodu (v rozmezí 6-59). Operováno v akutním stadiu NEC bylo deset novorozenců, devět dětí bylo léčeno konzervativně. U pěti dětí operovaných v akutním stadiu byla založena dělená ileostomie, u čtyřech byl k derivaci střevního obsahu použit T-drén a u jednoho břišní drén. Z konzervativně léčených byly tři děti následně operovány pro intestinální strikturu po NEC, dvě se zhojily při konzervativní léčbě a čtyři zemřely při rychlé progresi NEC bez chirurgické léčby. Celková mortalita v souboru byla 42 % (zemřelo 8 dětí). Závěry: Léčba NEC u extrémně nezralých novorozenců s porodní hmotností pod 1000 g vyžaduje komplexní spolupráci neonatologa a dětského chirurga. Resekce nekrotického střeva se založením stomií zůstává standardním postupem u nestabilních novorozenců s lokalizovanou formou onemocnění.
Aim: The aim of this study is to assess a contemporary treatment potential for necrotizing enterocolitis in newborns with birth weights under 1000 g. Methodology and Subjects: This is a retrospective study of clinical and pathological data in a group of 19 newborns with birth weights under 1000 g treated for necrotizing colitis (NEC) by the authors' team from 1999 to 2003. Only newborns with the second and third grade NEC according to Bell were included in the trial group. Results: The trial group included 19 newborns born in the 26th gestation week, on average (ranging from 23to 31) with a mean birth weight of 711 grams (the range between 460-980 g). Their NEC appeared on the 18th postnatal day, on average (the range between 6-59). Ten newborns were operated in the acute stage of their NEC, nine were treated conservatively. Five infants operated in the acute stage had separational ileostomy conducted. four had a T-drain introduced and one had an abdominal drain introduced. In the conservatively managed group. three infants were consequently operated for intestinal strictures following their NEC, two recovered during the conservative treatment and four exited due to a fast progress of their NEC without surgery. The total mortality rate of the trial group was 42% (8 infants exited).
- MeSH
- Digestive System Surgical Procedures methods MeSH
- Child MeSH
- Research Support as Topic MeSH
- Humans MeSH
- Enterocolitis, Necrotizing diagnosis surgery therapy MeSH
- Infant, Very Low Birth Weight MeSH
- Infant, Newborn MeSH
- Retrospective Studies MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Infant, Newborn MeSH
Nekrotizujúca enterokolitída patrí k závažným akútnym ochoreniam novorodeneckého veku. Postihuje najmä nedonosených novorodencov s nízkou pôrodnou hmotnosťou pod 1500 gramov. Napriek rozsiahlemu výskumu etiológia tohto ochorenia zostáva nejasná. Väčšina autorov sa prikláňa k multifaktoriálnej príčine. Výskumníci sa pokúšajú určiť rôzne laboratórne ako aj klinické faktory, ktoré by mohli slúžiť ako kritéria na chirurgickú intervenciu. Senzitivita a špecificita týchto testov a laboratórnych vyšetrení odhaľujú len ochorenia V pokročilom štádiu a v štádiu perforácie gastrointestinálneho traktu (GIT). Hlavným chirurgickým prístupom k liečbe tohoto ochoreiúa stále zostáva laparotómia a resekcia nekrotického úseku čreva s enterostómiou. U limitovaného počtu detí do úvahy prichádza aj resekcia časti nekrotického čreva s primárnou anastomózou. U niektorých velmi ťažkých stavov a u detí s nízkou pôrodnou hmotnosťou pod 1000 gramov, mala by stačiť len peritoneálna drenáž a následná second look operácia. Ide o ochorenie, ktoré si vyžaduje maximálne individuálny predoperačnej a pooperačnej starostlivosti. predoperačnej a pooperačnej starostlivosti.
Necrotizing enterocolitis is an acute neonatal disease. It affects in particular premature neonates with a birth weight lower than 1500 g. Despite extensive research the etiology of the disease remains obscure. The majority of authors assume multifactorial causes. Research workers try to detect various laboratory and clinical factors which could serve as criteria for surgical intervention. The sensitivity and specificity of these tests and laboratory examinations detect the disease only in an advanced stage and in the stage of perforation of the gastrointestinal tract (GIT). The main surgical approach to the treatment of this disease remains laparotomy and resection of the necrotic portion of the gut with enterostomy. In a limited number of children resection of a portion of the necrotic gut with primary anastomosis is possible. In some very serious conditions and in infants with a birth weight below 1000 g peritoneal drainage and subsequent „second look" surgery should be sufficient. It is a disease with calls for a maximum individual approach and there are no accurate defined instructions for surgical treatment. The surgeon's experience and the standard of preoperative and postoperative care are decisive.
- MeSH
- Surgical Procedures, Operative methods MeSH
- Child MeSH
- Indomethacin adverse effects therapeutic use MeSH
- Laparotomy MeSH
- Humans MeSH
- Enterocolitis, Necrotizing diagnosis drug therapy surgery MeSH
- Infant, Newborn, Diseases diagnosis etiology surgery MeSH
- Pneumoperitoneum MeSH
- Postoperative Complications etiology mortality MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Review MeSH
Úvod: Nekrotizující enterokolitida (NEC) je závažné zánětlivé onemocnění postihující převážně nezralé novorozence. I přes pokrok v přístupu k takto ohroženým novorozencům, poznatkům v oblasti prevence a zlepšující se diagnostice, zůstává NEC jednou z vedoucích příčin mortality i morbidity předčasně narozených novorozenců. Metodika: Retrospektivní kohortová analýza. Výsledky: Ve spádovém regionu Perinatologického centra FN Hradec Králové se v letech 2010 -2017 narodilo 100 233 novorozenců, z toho 7165 novorozenců s porodní hmotností <2500 g, 907 novorozenců s porodní hmotností <1500 g a 119 novorozenců s porodní hmotností <750 g. Klasifikace NEC (IIa a vyšší) dle modifikované Bellovy stupnice byla realizována při stanovení diagnózy, v průběhu konzervativní léčby mohla progredovat. NEC byla diagnostikována v 86 případech (incidence 0,86 ‰). Incidence NEC v hmotnostní kategorii <1500 g byla v našem regionu 5,6 %, v hmotnostní kategorii <1000 g 10,5 %, u novorozenců s porodní hmotností V750 g 12,6 %. Letalita novorozenců s porodní hmotností <750 g dosahovala 53 %, u novorozenců s hmotností <1500 g 24,5 %; v celém souboru 86 pacientů s NEC činila 23 %. Letalita podle gestačního stáří byla ve skupině novorozenců narozených mezi 24. až 28. týdnem 33,3 %, u novorozenců narozených mezi 29. až 32. gestačním týdnem 22,7 % a ve skupině novorozenců narozených po 33. týdnu těhotenství 10,7 %. Stadium II jsme diagnostikovali celkem 58krát, stadium III 28krát. Konzervativně bylo léčeno 22 pacientů, zbývajících 64 pacientů podstoupilo chirurgickou léčbu. Mezi chirurgicky léčenými pacienty byla souhrnná letalita 30 %, mezi konzervativně léčenými pacienty byla souhrnná letalita 4,5 %. Průměrná délka hospitalizace u konzervativně léčených pacientů byla 49 dní, u pacientů léčených chirurgicky 84 dní. Závěr: Výše uvedená data jsou srovnatelná s výsledky publikovanými v západní Evropě a Severní Americe. V posledních letech lze v našem souboru pozorovat trend mírného poklesu výskytu tohoto onemocnění, i tak zůstává nekrotizující enterokolitida velmi závažným onemocněním, které zásadně ovlivňuje přežití i dlouhodobou prognózu předčasně narozených novorozenců.
Introduction: Necrotizing enterocolitis (NEC) is a serious inflammatory disease affecting predominantly immature newborns. NEC ranges from moderate stages with mucosal intestine impairment to catastrophic illness with impairment of the entire alimentary canal including its perforation, development of peritonitis and shock. Despite of care improvement NEC remains the leading cause of morbidity and mortality in premature newborns. Methods: Retrospective cohort analysis. Results: During the years 2010-2017, 100 233 newborns were born in the region served by the Perinatological Centre of the University Hospital in Hradec Králové. This includes 7165 newborns with birth weight <2500 g, 907 newborns with birth weight <1500 g and 119 newborns with birth weight <750 g. NEC classification (IIa and higher) according to the modified Bell’s scale was diagnosed in total 86 cases, corresponding to 0.86 ‰ incidence. NEC incidence was 5.6% in weight category <1500 g, 10.5% in weight category <1000 g and 12.6% in weight category <750 g. Lethality of newborns was 53% in weigh category <750 g, 24.5% in weight category <1500 g and 23% in the entire group of NEC patients. Gestational age-related lethality was 33.3% for newborns born between 24th and 28th week of gestation, 22.7% for newborns born between 29th and 32nd week of gestation, and 10.7% for newborns born after 33rd week of gestation. NEC stage II classification according to the modified Bell’s scale was diagnosed 58 times in total, stage III was diagnosed 28 times in total. In total, 22 patients were treated conservatively and 64 patients underwent surgical treatment. The overall lethality was 4.5% among the conservatively treated patients and 30% among the surgically treated patients. The average length of hospitalization was 49 days among the conservatively treated patients and 84 days among the surgically treated patients. Conclusion: Our results are comparable to those published in other studies in Western Europe and North America. Although we can see slight decrease of the NEC incidence in our region during the last several years, necrotizing enterocolitis remains a very serious disease that fundamentally affects the survival and long-term outcome of premature newborns.
Nekrotizujúca enterokolitída (NEC) samôže zriedkavo vyvinúť aj u donosených novorodencov. Pre NEC u donosených je typická manifestácia ochorenia vo veku 2–4 dní, prednostné postihnutie hrubého čreva a prítomnosť iného primárneho ochorenia, ktoré negatívne ovplyvňuje prekrvenie čreva. Etiopatogenéza je nejasná, dôležitá je prítomnosť iného rizikového faktora, kolonizácie čreva patogénnou mikroflórou a perorálna výživa. Pre včasnú diagnostiku je prínosné sonografické vyšetrenie, ktoré ukáže prítomnosť plynu v črevnej stene už v začiatočnom štádiu ochorenia. Kazuistika uvádza prípad dieťaťa narodeného v 36. gestačnom týždni s pôrodnou hmotnosťou 1950 g, Apgar 10/10, ktoré bolo od druhého dňa liečené antibiotikami pre perinatálnu infekciu (kolonizácia E. coli po narodení, leukopénia, trombocytopénia), s negatívnou hemokultúrou, bez hemodynamickej instability. Vo veku 4 dní dieťa zvracia krv, na RTG brucha viditeľná pneumatóza čreva – nález charakteristický pre NEC. Napriek liečbe o 24 hodín neskôr diagnostikované pneumoperitoneum, chirurgický výkon je pre neliečiteľnú koagulopatiu kontraindikovaný. Dieťa zomrelo vo veku 6 dní. Patologicko-anatomický nález potvrdil prítomnosť rozsiahlej nekrotizujúcej enterokolitídy s perforáciou a difúznou peritonitídou.
Necrotizing enterocolitis (NEC) may rarely develop in full-term newborns. NEC in term infants is characterised by the early onset at the age of 2–4 days, the colon is the typical location of inflammation and necrosis. The third difference as compared to preterm babies is the association with previous underlying illness that alters intestinal blood flow. Aetiology of NEC remains poorly understood but the presence of other risk factor, colonisation of the gut with pathogenic microorganisms and enteral feeding seem to be of great importance. Sonographic examination may be helpful for the early diagnosis of patients with NEC as the gas (granular echogenicities) in the bowel wall can be seen in early stage of NEC. In this report we present a case of a boy born at 36 gestational weeks, his birth weight was 1950 g, Apgar score 10, 10 in the first and fifth minutes, respectively. On the second day antibiotics were indicated due to perinatal infection (colonisation with Escherichia coli, low leukocyte count, low platelet count) with negative blood culture, the baby was hemodynamically stable. At the age of 4 days bloody vomiting appeared, abdominal radiography showed pneumatosis intestinalis – the typical finding for NEC. Despite the treatment 24 hours later pneumoperitoneum appeared, surgical intervention was contraindicated due to untreatable coagulopathy. The baby died at the age of 6 days. At autopsy the presence of extensive NEC with bowel perforation and diffuse peritonitis were confirmed.
- MeSH
- Diagnosis, Differential MeSH
- Financing, Organized MeSH
- Humans MeSH
- Morbidity MeSH
- Enterocolitis, Necrotizing etiology classification therapy MeSH
- Infant, Newborn, Diseases MeSH
- Infant, Newborn MeSH
- Prognosis MeSH
- Risk Factors MeSH
- Ultrasonography MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Infant, Newborn MeSH
- Publication type
- Case Reports MeSH
BACKGROUND: The nosocomial occurrence of mycotic infections negatively affects results of the neonatal care in newborns in the sense of their increased mortality and morbidity.
- MeSH
- Abdomen microbiology MeSH
- Fatal Outcome MeSH
- Cross Infection complications mortality MeSH
- Intensive Care, Neonatal MeSH
- Humans MeSH
- Mucormycosis complications mortality MeSH
- Enterocolitis, Necrotizing etiology mortality MeSH
- Infant, Premature MeSH
- Infant, Low Birth Weight MeSH
- Infant, Newborn MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Infant, Newborn MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Necrotizing enterocolitis (NEC) is one of the most devastating intestinal diseases observed in preterm in the first days of life. Researchers have recently focused on potential predictive biomarkers for early and concomitant diagnoses. Thus, we inquired about the linkage of intestinal dysbiosis, one of the most important factors in NEC development to the gut microbiota. In this study, the systematic differences in the bacterial composition between neonates affected by NEC and healthy newborns were highlighted by metagenomic analysis. The next-generation sequencing of the V3-V4 variable region of the 16S rRNA gene and gene-specific qPCR analyzed the untargeted gut microbiota. Total bacteria, total and fecal coliform loads in stool samples with NEC were higher than control. OTU-level relative abundances of NEC infant was characterized by Firmicutes and Bacteroidetes at phylum levels. At the genus level, NEC stool was identified by the lack of Klebsiella and the presence of Roseburia, Blautia, and Parasutterella. Finally, Clostridium fessum was the predominant species of Clostridium genus in disease and healthy specimens at the species level, whereas Clostridium jeddahitimonense was at NEC diagnosis. Despite a strong relationship between pathophysiology and characterization of gut microbiota at a clinical diagnosis of NEC, our results emphasize the broad difficulty in identifying potential biomarkers.
- MeSH
- Bacteria * classification genetics isolation & purification MeSH
- DNA, Bacterial genetics MeSH
- Dysbiosis microbiology MeSH
- Feces * microbiology MeSH
- Humans MeSH
- Metagenomics MeSH
- Enterocolitis, Necrotizing * microbiology MeSH
- Infant, Premature MeSH
- Infant, Newborn MeSH
- RNA, Ribosomal, 16S * genetics MeSH
- Gastrointestinal Microbiome * MeSH
- High-Throughput Nucleotide Sequencing MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Infant, Newborn MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Necrotizing enterocolitis (NEC) is a severe intestinal condition primarily affecting preterm neonates. It has a high mortality rate, particularly in infants with a birthweight of below 1,500 g or for those requiring surgical intervention. The European Reference Network for Inherited and Congenital Anomalies (ERNICA) has developed a clinical practice guideline to aid clinical decision-making pertaining to the surgical treatment and management of NEC in preterm neonates. This guideline was developed in accordance with the Guidelines 2.0 checklist and GRADE methodology. A multidisciplinary group of Europe's top experts collaborated with patient representatives to develop this guideline. After selecting critical points in care for which recommendations are required, a systematic review of the literature and critical appraisal of the evidence was performed. The Evidence to Decision framework was used as a guide to structure the consensus meetings and draft the recommendations. The panel developed seven recommendations and three good practice statements on the following topics: indications for surgery, peritoneal drainage, surgical technique, management of extensive NEC, enteral feeding, and neurodevelopmental outcomes in premature neonates with NEC. The certainty of evidence was graded as (very) low for most recommendations. However, the panel weighed up the benefits and harms in light of all relevant arguments and expert opinion. This guideline provides recommendations on caring for premature neonates with NEC. These recommendations can assist clinicians in their care decisions and can inform families on treatment options and relevant considerations. This guideline will be revised every 5 years to ensure it remains up to date.
- MeSH
- Enteral Nutrition MeSH
- Clinical Decision-Making MeSH
- Humans MeSH
- Evidence-Based Medicine MeSH
- Enterocolitis, Necrotizing * surgery diagnosis MeSH
- Infant, Premature MeSH
- Infant, Newborn MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Publication type
- Journal Article MeSH
- Practice Guideline MeSH
- Systematic Review MeSH
- Geographicals
- Europe MeSH
