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Wu D, Van Oerle R, Martinez A, Piper HG. Risk Factors for Infection in Neonates With Intestinal Failure. J Pediatr Surg 2024; 59:854-857. [PMID: 38365474 DOI: 10.1016/j.jpedsurg.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/18/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Neonates with intestinal failure (IF) are at risk for infection due to central venous access, and intestinal surgery. Infection can cause systemic inflammation and sepsis, potentially affecting growth. The purpose of this study was to identify risk factors for, and the potential impact of infection to help with preventative strategies. METHODS A retrospective review of infants with IF, at a single centre from 2018 to 2022 was conducted. Clinical characteristics, intestinal pathology, nutritional intake, and growth were compared among infants with bloodstream infection (BSI), other infection (OI) (urinary, respiratory, or wound), or no infection (NI) within 2 months of diagnosis. Mann-Whitney and Kruskal-Wallis tests were used for comparisons with p-values <0.05 considered significant. RESULTS Eighty-six infants were included, with gastroschisis (41%) and necrotizing enterocolitis (26%) the most common diagnoses. Fifty-nine % of infants developed infection (22% BSI and 37% OI). Those with BSI or OI had a lower gestational age and birthweight, and were more likely to have a stoma. All infants with complex gastroschisis developed infection compared to 38% of infants with simple gastroschisis. Median daily weight gain was suboptimal across all groups and did not differ over 6 weeks following infection. CONCLUSION Most infants with IF develop infection shortly after diagnosis. Risk factors include prematurity, complex gastroschisis, and the presence of a stoma. Growth was suboptimal but did not differ among infants with or without infection. TYPE OF STUDY Retrospective Review. LEVEL OF EVIDENCE Level III Retrospective Comparative Study.
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Affiliation(s)
- Dana Wu
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rhonda Van Oerle
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Center, Vancouver, BC, Canada
| | - Andrea Martinez
- Division of Gastroenterology, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada
| | - Hannah G Piper
- Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada.
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Choi S, Casey L, Albersheim S, Van Oerle R, Irvine MA, Piper HG. Urine sodium to urine creatinine ratio as a marker of total body sodium in infants with intestinal failure. J Pediatr Surg 2022; 57:937-940. [PMID: 35078592 DOI: 10.1016/j.jpedsurg.2021.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Urine sodium (UNa) is a measure of total body sodium in infants with intestinal failure (IF) but can be misleading as it does not reflect volume status. Urine sodium to urine creatinine ratio (UNa:UCr) may offer a more accurate measure, but is not routinely used. This study compares UNa:UCr to UNa as a maker of sodium status in infants with IF. METHODS A retrospective review of infants with IF, from a single center, from 2018 to 2020 was conducted (REB H20-00,816). IF etiology, intestinal anatomy, nutritional intake, urine electrolytes and anthropometrics were collected. Linear mixed effects models adjusting for repeated measures were used to associate UNa and UNa:UCr with weight gain and sodium intake. RESULTS Twenty-two infants with a median gestational age of 31 weeks were included. IF etiology included gastroschisis (41%), necrotizing enterocolitis (23%), and intestinal perforation (14%). Infants had an average of 3 paired UNa and UNa:UCr measures for a total of 74 paired measurements. UNa:UCr more strongly correlated with sodium intake compared to UNa (R = 0.25, p = 0.032 vs. R = 0.10, p = 0.38). Overall, neither UNa (p = 0.21) nor UNa:UCr (p = 0.16) were significantly correlated with weight gain. However, for infants receiving ≤50% nutrition enterally, weight gain correlated with UNa (p = 0.01) and UNa:UCr (p = 0.01). UNa:UCr >35 predicted adequate growth regardless of enteral intake (92% sensitivity, 59% specificity). CONCLUSION UNa:UCr is a measure of total body sodium that correlates with sodium intake in infants with IF. Our study indicates UNa:UCr >35 is associated with adequate growth and can be used to guide further validation studies.
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Affiliation(s)
- Seungwon Choi
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda Casey
- Department of Pediatrics, Faculty of Medicine, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada
| | - Susan Albersheim
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Rhonda Van Oerle
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Michael A Irvine
- BC Centre for Disease Control, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Hannah G Piper
- Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada.
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Peters FB, Bone JN, Van Oerle R, Albersheim S, Casey L, Piper H. The Importance of the ileocecal valve and colon in achieving intestinal independence in infants with short bowel syndrome. J Pediatr Surg 2022; 57:117-121. [PMID: 34696920 DOI: 10.1016/j.jpedsurg.2021.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Infants with short bowel syndrome (SBS) wean from parenteral nutrition (PN) support at variable rates. Small bowel length is a predictor, but the importance of the ileocecal valve (ICV) and colon are unclear. We aim to determine if the ICV and/or colon predict enteral autonomy. METHODS Infants from a single intestinal rehabilitation program were retrospectively reviewed. Etiology of SBS, intestinal anatomy, and duration of nutritional support were collected for three years. The primary outcome was time to full enteral nutrition. ANCOVA and Cox proportional hazards model were used, with p < 0.05 significant. RESULTS 55 infants with SBS were included. After accounting for the effect of small bowel, PN duration was shorter for infants with the ICV compared to those without (mean 218 vs. 538 days, p = 0.003), and had a more significant effect on infants with ≤50% of small bowel. Increased small bowel length was a positive predictor of weaning. Patients with ≤50% of colon spent less time on PN with the ICV, compared to without (mean 220 vs 715 days, p = 0.009). CONCLUSIONS Preservation of the ICV was associated with shorter duration of PN support, while colon was not. Small bowel length is a positive predictor of enteral autonomy. LEVEL OF EVIDENCE Level III retrospective comparative study TYPE OF STUDY: Retrospective review.
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Affiliation(s)
- Francesca Bell Peters
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T1Z3, Canada.
| | - Jeffrey N Bone
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Rhonda Van Oerle
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Center, Vancouver, BC, Canada
| | - Susan Albersheim
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Center, Vancouver, BC, Canada
| | - Linda Casey
- Department of Pediatrics, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada
| | - Hannah Piper
- Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada.
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Que J, Van Oerle R, Albersheim S, Panczuk J, Piper H. The effect of daily probiotics on the incidence and severity of necrotizing enterocolitis in infants with very low birth weight. Can J Surg 2021; 64:E644-E649. [PMID: 34853053 PMCID: PMC8648346 DOI: 10.1503/cjs.016920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Necrotizing enterocolitis remains a leading cause of morbidity and mortality in premature infants. The role of prophylactic probiotics in its prevention is unclear. This study evaluates the effect of routine probiotics on the incidence and severity of necrotizing enterocolitis in infants with very low birth weight in the neonatal intensive care unit. Methods: This retrospective cohort study compared infants cared for at a single institution before and after implementation of routine probiotic administration (2014– 2018). Babies born after July 2016 received probiotics containing Bifidobacterium and Lactobacillus daily until 35 weeks corrected gestational age. Baseline characteristics, necrotizing enterocolitis incidence and severity, infections, mortality, and length of stay were compared between groups. Results: Of the 665 infants included in the study, 310 received probiotics and 355 did not. The 2 groups did not differ with regard to gestational age, birth anthropometrics, mode of delivery, comorbidities, and type of enteral feed. The incidence of necrotizing enterocolitis (Bell’s stage 2 of 3) was similar between groups (4% v. 5%, p = 0.35), as was its severity (p = 0.10). In addition, there were no significant differences in mortality and length of stay between the groups. Significantly fewer infants receiving probiotics developed infections (27% v. 34%, p = 0.046), with the rate of urinary tract infections having the largest reduction. Conclusion: The routine use of Bifidobacterium and Lactobacillus probiotics in infants with very low birth weight did not significantly affect the incidence and severity of necrotizing enterocolitis. However, the use of probiotics was associated with fewer overall infections.
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Affiliation(s)
- Jessica Que
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Que); the BC Women's Hospital and Health Centre, Vancouver, BC (Van Oerle); the Department of Pediatrics, Faculty of Medicine, University of British Columbia/BC Children's Hospital, Vancouver, BC (Albersheim, Panczuk); and the Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC (Piper)
| | - Rhonda Van Oerle
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Que); the BC Women's Hospital and Health Centre, Vancouver, BC (Van Oerle); the Department of Pediatrics, Faculty of Medicine, University of British Columbia/BC Children's Hospital, Vancouver, BC (Albersheim, Panczuk); and the Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC (Piper)
| | - Susan Albersheim
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Que); the BC Women's Hospital and Health Centre, Vancouver, BC (Van Oerle); the Department of Pediatrics, Faculty of Medicine, University of British Columbia/BC Children's Hospital, Vancouver, BC (Albersheim, Panczuk); and the Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC (Piper)
| | - Julia Panczuk
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Que); the BC Women's Hospital and Health Centre, Vancouver, BC (Van Oerle); the Department of Pediatrics, Faculty of Medicine, University of British Columbia/BC Children's Hospital, Vancouver, BC (Albersheim, Panczuk); and the Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC (Piper)
| | - Hannah Piper
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Que); the BC Women's Hospital and Health Centre, Vancouver, BC (Van Oerle); the Department of Pediatrics, Faculty of Medicine, University of British Columbia/BC Children's Hospital, Vancouver, BC (Albersheim, Panczuk); and the Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC (Piper).
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