1
|
Rebai N, Lopriore E, Bekker V, Slaghekke F, Schoenaker MHD, Groene SG. Necrotizing enterocolitis in monochorionic twins: Insights from an identical twin model. Early Hum Dev 2024; 194:106052. [PMID: 38781714 DOI: 10.1016/j.earlhumdev.2024.106052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
Necrotizing enterocolitis (NEC) is a major cause of neonatal morbidity and mortality in preterm neonates, yet its pathophysiology remains unclear. The aim of this study is to evaluate risk factors for NEC using an identical twin model. In this case-control study, all monochorionic twin pairs born in our center in 2002-2020 were retrospectively reviewed for NEC. Potential risk factors for NEC were studied. For within-pair comparison, outcomes were compared between affected and unaffected twins. Within-pair analyses showed that the twin with NEC had a lower birth weight compared to its unaffected co-twin (1100 (913-1364) vs. 1339 (1093-1755) grams). Median gestational age at birth and birth weight were lower in twin pairs in the NEC-group compared to the no-NEC group, 29.1 weeks (27.8-30.8) versus 33.6 (30.7-36.0) and 1221 g (1010-1488) versus 1865 (1356-2355) respectively. Twin pregnancies in the NEC-group were more often complicated by twin-to-twin transfusion syndrome compared to the no-NEC-group (70 % (14/20) vs. 49 % (472/962)), particularly when treated with amnioreduction. This unique population of identical twins confirms that preterm neonates with a relatively lower birth weight are more prone to develop NEC compared to their co-twin, regardless of other genetic, maternal and obstetrical factors.
Collapse
Affiliation(s)
- Nour Rebai
- Neonatoloy, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
| | - Enrico Lopriore
- Neonatoloy, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Vincent Bekker
- Neonatoloy, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Femke Slaghekke
- Department of Obstetrics, Division of Fetal Therapy, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Michiel H D Schoenaker
- Neonatoloy, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands; Willem-Alexander Children's Hospital, Laboratory for Pediatric Immunology, Department of Pediatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Sophie G Groene
- Neonatoloy, Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| |
Collapse
|
2
|
Elsayed Ramadan OM, Alruwaili MM, Alruwaili AN, Elsharkawy NB, Abdelaziz EM, Zaky ME, Shaban MM, Shaban M. Nursing practice of routine gastric aspiration in preterm infants and its link to necrotizing enterocolitis: is the practice still clinically relevant? BMC Nurs 2024; 23:333. [PMID: 38760751 PMCID: PMC11100149 DOI: 10.1186/s12912-024-01994-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
The practice of routine gastric residual aspiration in preterm infants remains controversial, with conflicting evidence regarding its impact on necrotizing enterocolitis (NEC). As front-line caregivers, nurses play a vital role in gastric aspiration procedures and must be informed by evidence. This quasi-experimental nursing study aimed to assess whether gastric aspiration is clinically relevant in reducing the risk of NEC in preterm infants.A total of 250 preterm infants from two NICUs in Egypt were allocated to the gastric aspiration (n = 125) and non-aspiration (n = 125) groups. Feeding practices, gastric residuals, and incidence/severity of NEC were compared between groups according to modified Bell's criteria. Risk factors were analyzed using multivariate regression. There were no significant baseline differences between the groups. The gastric residual attributes and feeding outcomes did not differ substantially from aspiration. The overall incidence of NEC was 14-15%, with no significant differences in the odds of onset or progression of NEC by stage between the groups. Lower gestational age and birth weight emerged as stronger predictors of NEC. Routine gastric aspiration does not appear to directly prevent or reduce the severity of NEC in this population. Although gastric residuals retain clinical importance, study findings question assumptions that aspiration protects against NEC and informs nursing practice. Evidence-based feeding protocols must continually evolve through ongoing research on modifiable risk factors for this devastating intestinal disease in preterm infants.
Collapse
Affiliation(s)
| | | | | | - Nadia Bassuoni Elsharkawy
- College of Nursing, Jouf University, Sakaka, Saudi Arabia, 72388
- Maternal and Newborn Health Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
| | - Enas Mahrous Abdelaziz
- College of Nursing, Jouf University, Sakaka, Saudi Arabia, 72388
- Psychiatric Mental Health Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
| | - Mohammed Elsayed Zaky
- College of Nursing, Jouf University, Sakaka, Saudi Arabia, 72388
- Medical Surgical Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
| | - Marwa Mamdouh Shaban
- Lecturer of Community Health Nursing, Faculty of Nursing, Cairo University, Cairo, Egypt
| | - Mostafa Shaban
- College of Nursing, Jouf University, Sakaka, Saudi Arabia, 72388
- Geriatric Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
| |
Collapse
|
3
|
Roberts AG, Younge N, Greenberg RG. Neonatal Necrotizing Enterocolitis: An Update on Pathophysiology, Treatment, and Prevention. Paediatr Drugs 2024; 26:259-275. [PMID: 38564081 DOI: 10.1007/s40272-024-00626-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
Necrotizing enterocolitis (NEC) is a life-threatening disease predominantly affecting premature and very low birth weight infants resulting in inflammation and necrosis of the small bowel and colon and potentially leading to sepsis, peritonitis, perforation, and death. Numerous research efforts have been made to better understand, treat, and prevent NEC. This review explores a variety of factors involved in the pathogenesis of NEC (prematurity, low birth weight, lack of human breast milk exposure, alterations to the microbiota, maternal and environmental factors, and intestinal ischemia) and reports treatment modalities surrounding NEC, including pain medications and common antibiotic combinations, the rationale for these combinations, and recent antibiotic stewardship approaches surrounding NEC treatment. This review also highlights the effect of early antibiotic exposure, infections, proton pump inhibitors (PPIs), and H2 receptor antagonists on the microbiota and how these risk factors can increase the chances of NEC. Finally, modern prevention strategies including the use of human breast milk and standardized feeding regimens are discussed, as well as promising new preventative and treatment options for NEC including probiotics and stem cell therapy.
Collapse
|
4
|
Xie YL, Lai SH, Liu SJ, Xiu WL. Risk factors of necrotizing enterocolitis in twin preterm infants. BMC Pediatr 2024; 24:210. [PMID: 38521896 PMCID: PMC10960427 DOI: 10.1186/s12887-024-04701-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024] Open
Abstract
PURPOSE This study was aimed to investigate the risk factors of necrotizing enterocolitis (NEC) in twin preterm infants. METHODS The clinical data of 67 pairs of twin preterm infants admitted to the neonatal department of our hospital from January 2010 to December 2021 were retrospectively collected. One of the twins had NEC (Bell II and above) and the other twin without NEC. They were divided into NEC group and control group according to whether NEC occurred or not. RESULTS Univariate analysis showed that NEC was associated with congenital heart disease, small for gestational age, mild asphyxia at birth and feeding intolerance (P < 0.05). CONCLUSION Occurrence of NEC was associated with congenital heart disease, small for gestational age, and asphyxia at birth. For twin preterm infants with congenital heart disease, small for gestational age, or asphyxia at birth, special attention should be paid to the occurrence of NEC to minimize and avoid the occurrence of NEC.
Collapse
Affiliation(s)
- Ying-Ling Xie
- Department of Neonatology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shu-Hua Lai
- Department of Neonatology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Su-Jia Liu
- Department of Neonatology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wen-Long Xiu
- Department of Neonatology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
| |
Collapse
|
5
|
Qu D, Bo P, Li Z, Sun Y. Effects of whole nutritional formula foods on nutritional improvement and intestinal flora in malnourished rats. Food Sci Nutr 2024; 12:1724-1735. [PMID: 38455205 PMCID: PMC10916550 DOI: 10.1002/fsn3.3865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 03/09/2024] Open
Abstract
Food for special medical purposes (FSMP) has received increasing attention as an enteral nutritional supplement. To investigate the effects of whole nutritional formula (WNF) containing dietary fiber and regular formula on nutritional supplementation and improvement of intestinal microecology, a rat malnutrition model was established with the formulations of WNF, FOS, and SDF (10, 20 g/kg bw) administered by gavage for 30 days. The results showed that the three formulations effectively improved the nutritional status of the malnourished rats, significantly increasing the level of IgG, increasing the abundance of Bacteroidetes, and affecting the content of propionic acid (PRO). The nutritional status of rats is closely related to growth performance, nutritional indexes, and immunoglobulin index, which cause changes in the composition of the intestinal flora. The above results showed that WNF positively affected the nutritional improvement, immune level, and intestinal health of rats. The comprehensive evaluation also suggested that the formulation containing ginseng water-soluble dietary fiber (ginseng-SDF) had the most significant effect.
Collapse
Affiliation(s)
- Di Qu
- Institute of Special Animal and Plant SciencesChinese Academy of Agricultural SciencesChangchunJilinChina
| | - Pan‐Pan Bo
- Institute of Special Animal and Plant SciencesChinese Academy of Agricultural SciencesChangchunJilinChina
- Institute of Chinese Medicinal MaterialsJilin Agricultural UniversityChangchunJilinChina
| | - Zhi‐Man Li
- Institute of Special Animal and Plant SciencesChinese Academy of Agricultural SciencesChangchunJilinChina
| | - Yin‐Shi Sun
- Institute of Special Animal and Plant SciencesChinese Academy of Agricultural SciencesChangchunJilinChina
| |
Collapse
|
6
|
Zhao S, Jiang H, Miao Y, Liu W, Li Y, Liu H, Wang A, Cui X, Zhang Y. Factors influencing necrotizing enterocolitis in premature infants in China: a systematic review and meta-analysis. BMC Pediatr 2024; 24:148. [PMID: 38418993 PMCID: PMC10903018 DOI: 10.1186/s12887-024-04607-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is a multifactorial gastrointestinal disease with high morbidity and mortality among premature infants. However, studies with large samples on the factors of NEC in China have not been reported. This meta-analysis aims to systematically review the literature to explore the influencing factors of necrotizing enterocolitis in premature infants in China and provide a reference for the prevention of NEC. METHODS PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Wanfang and VIP databases were systematically searched from inception to February 2023. We used Stata14.0 software to perform the systematic review and meta-analysis. We used fixed or random effects models with combined odds ratios (ORs) and 95% confidence intervals (CIs), and quality was evaluated using the Newcastle‒Ottawa Scale (NOS). RESULTS The total sample was 8616 cases, including 2456 cases in the intervention group and 6160 cases in the control group. It was found that 16 risk factors and 3 protective factors were related to necrotizing enterocolitis in premature infants. Septicemia (OR = 3.91), blood transfusion (OR = 2.41), neonatal asphyxia (OR = 2.46), pneumonia (OR = 6.17), infection (OR = 5.99), congenital heart disease (OR = 4.80), intrahepatic cholestasis of pregnancy (ICP) (OR = 2.71), mechanical ventilation (OR = 1.44), gestational diabetes mellitus (GDM) (OR = 3.08), respiratory distress syndrome (RDS) (OR = 3.28), hypoalbuminemia (OR = 2.80), patent ductus arteriosus (PDA) (OR = 3.10), respiratory failure (OR = 7.51), severe anemia (OR = 2.86), history of antibiotic use (OR = 2.12), and meconium-stained amniotic fluid (MSAF) (OR = 3.14) were risk factors for NEC in preterm infants in China. Breastfeeding (OR = 0.31), oral probiotics (OR = 0.36), and prenatal use of glucocorticoids (OR = 0.38) were protective factors for NEC in preterm infants. CONCLUSIONS Septicemia, blood transfusion, neonatal asphyxia, pneumonia, infection, congenital heart disease, ICP, GDM, RDS, hypoproteinemia, PDA, respiratory failure, severe anemia, history of antibiotic use and MSAF will increase the risk of NEC in premature infants, whereas breastfeeding, oral probiotics and prenatal use of glucocorticoids reduce the risk. Due to the quantity and quality of the included literature, the above findings need to be further validated by more high-quality studies.
Collapse
Affiliation(s)
- Shuliang Zhao
- School of Nursing, Shandong Second Medical University, Weifang, 261053, China
- Nursing Department Affiliated Hospital of Shandong Second Medical University, Weifang, 261031, China
| | - Huimin Jiang
- School of Nursing, Shandong Second Medical University, Weifang, 261053, China
| | - Yiqun Miao
- School of Nursing, Capital Medical University, Beijing, 100071, China
| | - Wenwen Liu
- Xiangya School of Nursing, Central South University, Changsha, 410000, China
| | - Yanan Li
- School of Nursing, Shandong Second Medical University, Weifang, 261053, China
| | - Hui Liu
- School of Nursing, Shandong Second Medical University, Weifang, 261053, China
| | - Aihua Wang
- School of Nursing, Shandong Second Medical University, Weifang, 261053, China.
| | - Xinghui Cui
- Nursing Department Affiliated Hospital of Shandong Second Medical University, Weifang, 261031, China.
| | - Yuanyuan Zhang
- School of Nursing, Shandong Second Medical University, Weifang, 261053, China
| |
Collapse
|
7
|
Liu J, Joseph S, Manohar K, Lee J, Brokaw JP, Shelley WC, Markel TA. Role of innate T cells in necrotizing enterocolitis. Front Immunol 2024; 15:1357483. [PMID: 38390341 PMCID: PMC10881895 DOI: 10.3389/fimmu.2024.1357483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024] Open
Abstract
Necrotizing enterocolitis (NEC) is a destructive gastrointestinal disease primarily affecting preterm babies. Despite advancements in neonatal care, NEC remains a significant cause of morbidity and mortality in neonatal intensive care units worldwide and the etiology of NEC is still unclear. Risk factors for NEC include prematurity, very low birth weight, feeding with formula, intestinal dysbiosis and bacterial infection. A review of the literature would suggest that supplementation of prebiotics and probiotics prevents NEC by altering the immune responses. Innate T cells, a highly conserved subpopulation of T cells that responds quickly to stimulation, develops differently from conventional T cells in neonates. This review aims to provide a succinct overview of innate T cells in neonates, encompassing their phenotypic characteristics, functional roles, likely involvement in the pathogenesis of NEC, and potential therapeutic implications.
Collapse
Affiliation(s)
- Jianyun Liu
- Department of Surgery, Section of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sharon Joseph
- Department of Surgery, Section of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Krishna Manohar
- Department of Surgery, Section of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jasmine Lee
- Department of Surgery, Section of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - John P. Brokaw
- Department of Surgery, Section of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - W. Christopher Shelley
- Department of Surgery, Section of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
| | - Troy A. Markel
- Department of Surgery, Section of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
| |
Collapse
|
8
|
Gandino S, Bzikowska‐Jura A, Karcz K, Cassidy T, Wesolowska A, Królak‐Olejnik B, Klotz D, Arslanoglu S, Picaud J, Boquien C, Bertino E, Moro GE, Weaver G. Vegan/vegetarian diet and human milk donation: An EMBA survey across European milk banks. MATERNAL & CHILD NUTRITION 2024; 20:e13564. [PMID: 37724510 PMCID: PMC10750000 DOI: 10.1111/mcn.13564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/19/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023]
Abstract
The nutritional adequacy of human milk (HM) from vegan/vegetarian mothers has been a matter of debate, and a variety of recommendations regarding the eligibility of these mothers as human milk donors exists. According to the latest evidence, HM from vegans/vegetarians is similar in its composition to that from omnivores, however, some differences may be observed regarding vitamin B12 and omega-3 fatty acids concentrations. Maternal supplementation of these compounds has been proven effective in increasing their HM concentration. With this survey, we aimed to explore the practices currently in use in European human milk banks (HMBs) regarding potential donors following vegan/vegetarian diets. The online survey was distributed to European HMBs between January and July 2022. A total of 188 HMBs were contacted, and 118 replied (response rate 63%). Vegan and vegetarian mothers were recommended supplements of vitamin B12 to be accepted as donors in 27% and 26% of HMBs, respectively. Additional omega-3 fatty acid supplementation was required in 8% HMBs. In the remaining HMBs, these mothers were either systematically excluded or included regardless of supplementation. The dosage of the recommended supplements was extremely variable. Fifty-one percent of HMBs were following recommendations to guide their practice, national or local recommendations mainly. Great variability in European HMBs practices towards potential donors following vegan/vegetarian diets exists. Some of these practices can result in loss of donors and/or in potential nutritional deficiencies. Standardised evidence-based recommendations on this issue and their implementation in daily HMB practice are needed.
Collapse
Affiliation(s)
- Serena Gandino
- Nuffield Department of Women's & Reproductive HealthUniversity of Oxford, John Radcliffe HospitalOxfordUK
- Neonatology DivisionUniversity of Turin, City of Health and Science of TurinTurinItaly
| | - Agnieszka Bzikowska‐Jura
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Department of Medical Biology, Faculty of Health SciencesMedical University of WarsawWarsawPoland
| | - Karolina Karcz
- Department of NeonatologyMedical University in WrocławWroclawPoland
| | - Tanya Cassidy
- Kathleen Lonsdale Institute for Health ResearchMaynooth UniversityKildareIreland
| | - Aleksandra Wesolowska
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Department of Medical Biology, Faculty of Health SciencesMedical University of WarsawWarsawPoland
| | | | - Daniel Klotz
- Department of Neonatology, Center for Pediatrics, Medical Center, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Sertac Arslanoglu
- Division of Neonatology, İstanbul Medeniyet UniversitySchool of MedicineİstanbulTurkiye
| | - Jean‐Charles Picaud
- Service de Neonatologie, Hopital Universitaire de la Croix‐RousseHospices civils de LyonLyonFrance
- Laboratoire CarMen, INSERM, INRAUniversite Claude Bernard Lyon1Pierre‐BeniteFrance
| | | | - Enrico Bertino
- Neonatology DivisionUniversity of Turin, City of Health and Science of TurinTurinItaly
| | - Guido E. Moro
- Italian Association of Human Milk Banks (AIBLUD)MilanItaly
| | | |
Collapse
|
9
|
Peila C, Spada E, Riboldi L, Capitanio M, Pellegrino F, Coscia A. Twinning as a risk factor for neonatal acute intestinal diseases: a case-control study. Front Pediatr 2023; 11:1308538. [PMID: 38161432 PMCID: PMC10755860 DOI: 10.3389/fped.2023.1308538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Acute intestinal diseases (AID), including necrotizing enterocolitis and spontaneous intestinal perforation, are a group of conditions that typically present in preterm infants, and are associated with an elevated mortality and morbidity rate. The risk factors for these diseases remain largely unknown. The aim of the study is to identify the correlation between twinning and the development of AID. Methods A single-center retrospective case-control study was conducted. We recruited all infants with a diagnosis of AID, confirmed by anatomopathology, recovered in NICU between 2010 and 2020. Considering the rarity of the outcome, 4 matched controls for each subject were randomly chosen from the overall population of newborns. Odds Ratio (OR) and 95% Confidence Interval (CI) were calculated using a conditional logistic regression model and a multivariate model by the creation of a Directed Acyclic Graph (www.dagitty.net). Results The study population resulted in 65 cases and 260 controls. The two groups present similar median gestational age and mean birthweight in grams. The cases have a higher frequency of neonatal pathology (defined as at least one of patent ductus arteriosus, early or late sepsis, severe respiratory distress) (84.6% vs. 51.9%), medically assisted procreation (33.8% vs. 18.8%) and periventricular leukomalacia (10.8% vs. 2.7%), and a lower frequency of steroids prophylaxis (67.7% vs. 86.9%). About 50% of cases needed surgery. The OR for the direct effect were difference from one using logistic regression booth without and with repeated measures statements: from 1.14 to 4.21 (p = .019) and from 1.16 to 4.29 (p = .016), respectively. Conclusions Our study suggests that twinning may be a risk factor for the development of AID. Due to the small number of cases observed, further studies on larger populations are needed.
Collapse
Affiliation(s)
- C. Peila
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - E. Spada
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
- Laboratorio Della Conoscenza Carlo Corchia—APS, Florence, Italy
| | - L. Riboldi
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - M. Capitanio
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - F. Pellegrino
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - A. Coscia
- Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| |
Collapse
|
10
|
Walter J, O'Toole PW. Microbe Profile: The Lactobacillaceae. MICROBIOLOGY (READING, ENGLAND) 2023; 169:001414. [PMID: 38088348 PMCID: PMC10765037 DOI: 10.1099/mic.0.001414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023]
Abstract
The bacterial family Lactobacillaceae (the lactobacilli) occupy a unique role in microbiology due to their beneficial role in both human cultural history and biology, from the food preservation of hunter gatherers-turned-farmers, through the prevention of scurvy in seafarers exploring new worlds, and the health-promoting properties of species that colonize the human body as well as animals that are important for agriculture and pollination. The almost bewildering phenotypic and genomic complexity of the former genus Lactobacillus was recently reconciled with molecular taxonomy and phylogeny to establish robust genera comprising the Lactobacillaceae , whose main features are summarized in this Microbe Profile.
Collapse
Affiliation(s)
- Jens Walter
- School of Microbiology, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- School of Medicine, University College Cork, Cork, Ireland
| | - Paul W. O'Toole
- School of Microbiology, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| |
Collapse
|
11
|
Tews HC, Elger T, Grewal T, Weidlich S, Vitali F, Buechler C. Fecal and Urinary Adipokines as Disease Biomarkers. Biomedicines 2023; 11:biomedicines11041186. [PMID: 37189804 DOI: 10.3390/biomedicines11041186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
The use of biomarkers is of great clinical value for the diagnosis and prognosis of disease and the assessment of treatment efficacy. In this context, adipokines secreted from adipose tissue are of interest, as their elevated circulating levels are associated with a range of metabolic dysfunctions, inflammation, renal and hepatic diseases and cancers. In addition to serum, adipokines can also be detected in the urine and feces, and current experimental evidence on the analysis of fecal and urinary adipokine levels points to their potential as disease biomarkers. This includes increased urinary adiponectin, lipocalin-2, leptin and interleukin-6 (IL-6) levels in renal diseases and an association of elevated urinary chemerin as well as urinary and fecal lipocalin-2 levels with active inflammatory bowel diseases. Urinary IL-6 levels are also upregulated in rheumatoid arthritis and may become an early marker for kidney transplant rejection, while fecal IL-6 levels are increased in decompensated liver cirrhosis and acute gastroenteritis. In addition, galectin-3 levels in urine and stool may emerge as a biomarker for several cancers. With the analysis of urine and feces from patients being cost-efficient and non-invasive, the identification and utilization of adipokine levels as urinary and fecal biomarkers could become a great advantage for disease diagnosis and predicting treatment outcomes. This review article highlights data on the abundance of selected adipokines in urine and feces, underscoring their potential to serve as diagnostic and prognostic biomarkers.
Collapse
Affiliation(s)
- Hauke C Tews
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Tanja Elger
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Thomas Grewal
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Simon Weidlich
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Francesco Vitali
- Department of Medicine 1, Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Christa Buechler
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany
| |
Collapse
|
12
|
Therapeutic Potential of Gut Microbiota and Its Metabolite Short-Chain Fatty Acids in Neonatal Necrotizing Enterocolitis. Life (Basel) 2023; 13:life13020561. [PMID: 36836917 PMCID: PMC9959300 DOI: 10.3390/life13020561] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/31/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Short chain fatty acids (SCFAs), the principle end-products produced by the anaerobic gut microbial fermentation of complex carbohydrates (CHO) in the colon perform beneficial roles in metabolic health. Butyrate, acetate and propionate are the main SCFA metabolites, which maintain gut homeostasis and host immune responses, enhance gut barrier integrity and reduce gut inflammation via a range of epigenetic modifications in DNA/histone methylation underlying these effects. The infant gut microbiota composition is characterized by higher abundances of SCFA-producing bacteria. A large number of in vitro/vivo studies have demonstrated the therapeutic implications of SCFA-producing bacteria in infant inflammatory diseases, such as obesity and asthma, but the application of gut microbiota and its metabolite SCFAs to necrotizing enterocolitis (NEC), an acute inflammatory necrosis of the distal small intestine/colon affecting premature newborns, is scarce. Indeed, the beneficial health effects attributed to SCFAs and SCFA-producing bacteria in neonatal NEC are still to be understood. Thus, this literature review aims to summarize the available evidence on the therapeutic potential of gut microbiota and its metabolite SCFAs in neonatal NEC using the PubMed/MEDLINE database.
Collapse
|
13
|
Laje P. Abdominal Surgical Emergencies in Neonates. Neoreviews 2023; 24:e97-e106. [PMID: 36720694 DOI: 10.1542/neo.24-2-e97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Abdominal surgical emergencies are relatively common in neonates. Some of them are related to congenital diseases such as intestinal atresia and intestinal malrotation, whereas some are entirely postnatal conditions such as necrotizing enterocolitis and gastric perforation. While there is a wide range of clinical severity for these conditions, outcomes are most favorable with prompt identification and expeditious treatment. In this review, we describe the most common neonatal abdominal surgical emergencies, highlight the signs that can help with early detection, and explain the approach to diagnosis and management.
Collapse
Affiliation(s)
- Pablo Laje
- Division of General, Thoracic, and Fetal Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
- Children's Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
14
|
Kaech C, Kilgour C, Fischer Fumeaux CJ, de Labrusse C, Humphrey T. Factors That Influence the Sustainability of Human Milk Donation to Milk Banks: A Systematic Review. Nutrients 2022; 14:nu14245253. [PMID: 36558411 PMCID: PMC9785923 DOI: 10.3390/nu14245253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/18/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Donor human milk is the recommended alternative for feeding preterm or low birth weight infants when the mother's own milk is unavailable or not in sufficient quantity. Globally, the needs of vulnerable infants for donor human milk exceed the supply. This review aimed to identify the factors impacting the sustainability of human milk donation to milk banks. A systematic review of the literature was performed on eight databases to retrieve articles published until December 2021. The study protocol is available in PROSPERO (#CRD42021287087). Among the 6722 references identified, 10 studies (eight quantitative observational and two qualitative) met the eligibility criteria for a total of 7053 participants. Thirty factors influencing the sustainability of the donations to milk banks were identified and categorized as follows: (1) donation duration, (2) donors' infant features (e.g., gestational age, birth weight), (3) donors' features (e.g., socio-demographic characteristics, milk donation history), and (4) factors related to the milk bank and health care systems (awareness and support). The available evidence suggests that larger volumes of donated milk are associated with a longer duration of donation, as are early donation, previous milk donation, and donors with an infant of smaller weight and gestational age. Supporting and encouraging early donation and recruiting donors with infants of low birth weight and low gestational age could support longer donation times and greater volumes of milk donated. To identify efficient strategies and to draw appropriate recommendations to improve donor milk access, future studies should further explore the issues of the sustainability of human milk donation to milk banks.
Collapse
Affiliation(s)
- Christelle Kaech
- School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Science, The University of Queensland, St Lucia, QLD 4072, Australia
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1011 Lausanne, Switzerland
- Correspondence:
| | - Catherine Kilgour
- School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Science, The University of Queensland, St Lucia, QLD 4072, Australia
- The Royal Brisbane and Women’s Hospital, Queensland Health, Herston, QLD 4029, Australia
| | - Céline J. Fischer Fumeaux
- Department of Woman-Mother-Child, Lausanne University Hospital, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
| | - Claire de Labrusse
- HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1011 Lausanne, Switzerland
| | - Tracy Humphrey
- School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Science, The University of Queensland, St Lucia, QLD 4072, Australia
| |
Collapse
|
15
|
Lactoferrin as Possible Treatment for Chronic Gastrointestinal Symptoms in Children with Long COVID: Case Series and Literature Review. CHILDREN 2022; 9:children9101446. [PMID: 36291381 PMCID: PMC9600357 DOI: 10.3390/children9101446] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022]
Abstract
Long COVID is an emergent, heterogeneous, and multisystemic condition with an increasingly important impact also on the pediatric population. Among long COVID symptoms, patients can experience chronic gastrointestinal symptoms such as abdominal pain, constipation, diarrhea, vomiting, nausea, and dysphagia. Although there is no standard, agreed, and optimal diagnostic approach or treatment of long COVID in children, recently compounds containing multiple micronutrients and lactoferrin have been proposed as a possible treatment strategy, due to the long-standing experience gained from other gastrointestinal conditions. In particular, lactoferrin is a pleiotropic glycoprotein with antioxidant, anti-inflammatory, antithrombotic, and immunomodulatory activities. Moreover, it seems to have several physiological functions to protect the gastrointestinal tract. In this regard, we described the resolution of symptoms after the start of therapy with high doses of oral lactoferrin in two patients referred to our post-COVID pediatric unit due to chronic gastrointestinal symptoms after SARS-CoV-2 infection.
Collapse
|