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Microfluidic Model of Necrotizing Enterocolitis Incorporating Human Neonatal Intestinal Enteroids and a Dysbiotic Microbiome
Published on: July 28, 2023
Epidemiology of necrotizing enterocolitis--Part I: Changing regional trends in extremely preterm infants over 14
1School of Women's and Children's Health, University of New South Wales, Australia.
Insights
Necrotizing enterocolitis (NEC) incidence decreased in extremely premature infants despite increased survival. However, NEC remains a significant cause of mortality and morbidity in this vulnerable population.
Area of Science:
- Neonatalogy
- Perinatal Care
- Pediatric Surgery
Background:
- Advances in perinatal care have increased survival rates for extremely premature infants.
- This improved survival may impact the incidence and outcomes of necrotizing enterocolitis (NEC).
Purpose of the Study:
- To examine trends in NEC incidence, surgical intervention, and mortality.
- To analyze these trends in infants born between 24-28 weeks gestation over three epochs spanning 14 years.
Main Methods:
- Retrospective review of radiologically or surgically proven NEC cases from the New South Wales Neonatal Intensive Care Unit Study database.
- Analysis of data from three distinct epochs: 1986-87, 1992-93, and 1998-99.
- Inclusion of 360 infants in Epoch 1, 622 in Epoch 2, and 673 in Epoch 3.
Main Results:
- Neonatal intensive care unit admissions increased, while early and overall mortality decreased across epochs.
- NEC incidence in post-day 5 survivors significantly decreased in the latest epoch (6%) compared to earlier epochs (12%).
- No significant changes were observed in surgical intervention rates or NEC-related mortality; later epoch of birth was independently associated with reduced NEC risk.
Conclusions:
- Despite advancements in care and increased survival of extremely premature infants, the incidence of NEC has declined.
- Necrotizing enterocolitis continues to be a critical condition associated with high mortality and morbidity in this population.
Objectives:
Advances in perinatal care include exogenous surfactant, unequivocal acceptance of antenatal steroids and in utero and ex utero transfers to tertiary centres. Increased survival of extremely premature infants may change the incidence and outcome of necrotizing enterocolitis (NEC). Our aim was to examine the trends in the incidence of NEC, surgery and mortality in infants of 24-28 weeks gestation in a retrospective regional review of three epochs over a span of 14 years.
Methods:
Radiologically or surgically proven NEC cases were determined from the New South Wales Neonatal Intensive Care Unit Study database. Three epochs were examined. A total of 360 infants were admitted in 1986-87 (Epoch 1), 622 in 1992-93 (Epoch 2) and 673 in 1998-99 (Epoch 3).
Results:
There was an increase in neonatal intensive care unit admissions and a decrease in early and overall mortality of these very premature infants across the epochs. None of the early deaths was due to NEC. The incidence of NEC decreased in post day 5 survivors: 33 cases in Epoch 1 (12%), 60 cases in Epoch 2 (12%) and 34 cases in Epoch 3 (6%, P < 0.001). There was no change in surgical intervention (45%, 57% and 41%, respectively) or mortality due to NEC (37%, 27% and 32%). The reduced incidence of NEC was not singularly influenced by antenatal steroids, exogenous surfactant or outborn delivery. In a multivariate analysis, only later epoch of birth was independently associated with reduced NEC risk.
Conclusions:
With improved care and survival of extremely premature infants, the incidence of NEC has decreased, but it remains a disease of high mortality and morbidity.
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