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Abstract Objective To investigate the relationship between lactate acid level and hospitalization mortality in neonatal necrotizing enterocolitis (NEC). Method Paediatric-specific critical care database collected clinical data from the intensive care unit of Children's Hospital Affiliated to Zhejiang University Medical College from 2010 to 2018. Clinical and laboratory examination information of NEC patients was collected and divided into the death group and discharge group to find out the risk factors affecting the prognosis through univariate and multivariate analysis. Results Among 104 NEC neonates, the admission age was 7.5 days and the weight was 2.03 kg. Comparing the death group with the discharge group, there were significant differences in therapeutic regimen, pH, serum albumin, total protein, creatinine and lactate acid. Multivariate and threshold effect analysis showed that lactate acid had a linear correlation with hospital mortality, and newborns who died in the hospital had much higher lactate levels than those who were discharged. The mortality of NEC newborns increased by 40-45% for every 1 mmol/L increase in lactate acid level. Conclusions There was a correlation between lactate acid level and hospital mortality in newborns with NEC, and lactate acid level was an important index to evaluate the prognosis of NEC.
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Necrotizing enterocolitis (NEC) is the most common and serious acute intestinal necrotizing disease in newborns, especially in preterm infants.Infants with smaller gestational age are more prone to NEC.NEC-related mortality reaches up to 20%-30%, and 25% of the survivors suffer from serious sequelae such as the short bowel syndrome, growth restriction and long-lasting neurological dysplasia.Due to the atypical symptoms, early diagnosis of NEC is difficult, and the patient′s condition has already been serious at the time of diagnosis in general.Ultrasound and abdominal X-ray are traditional tools for the diagnosis of NEC.Serum, urine and fecal biomarkers have been gradually applied to clinical practice in recent years.Through integrating traditional tests with biological markers and optimizing the clinical decision-making system for NEC, precise clinical diagnosis and individualized treatment can be achieved.
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Necrotizing enterocolitis(NEC)is a serious gastrointestinal disease in the neonatal period and one of the main causes of death in premature infants.In recent years, with the advancement of neonatal intensive care, the survival rate of children with NEC has been improved.However, the survivors are often accompanied by poor neurological prognoses, such as periventricular leukomalacia, intraventricular hemorrhage, neurodevelopmental disorders.The pathogenesis of NEC has not been fully elucidated.This review discusses the factors that may influence NEC related brain injury, such as hypoxia and ischemia, inflammatory response, nutrition, and brain-gut axis, in order to provide an overview on the pathogenesis of NEC.
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Neonatal necrotizing enterocolitis(NEC)is a common acute abdomen in newborns, while intestinal stricture is one of the frequent complications of NEC.Post-NEC stricture often occurs in the colon, and has clinical features such as vomiting, abdominal distension and bloody stools.This complication has a high incidence, high risk of death, and is also affected by multiple factors such as disease severity, treatment method and recovery time of enteral nutrition.Early prediction, diagnosis and intervention can reduce the adverse effects of the disease on the growth and development of children.This article reviews the clinical characteristics, influencing factors and prediction of the post-NEC stricture.
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Objective To analyze the correlation between intestinal flora changes and neonatal necrotizing enterocolitis (NEC)through 16S rRNA metagenomic sequencing and bacterial culture. Methods From September 2018 to March 2019, 10 NEC cases and 6 controls were randomly selected in the neonatal ICU ward of Nanjing maternal and child health care hospital to analyze the 16S rRNA metagenomic diversity of the for intestinal flora. The fecal samples and corresponding environmental samples were corrected from 51 cases of NEC children and their case controls to isolate and culture Clostridium. Results The dispersion of samples within the case group was smaller than that of the control group, and the sample diversity was higher than that of the control group. In the isolation and culture of Clostridium, the overall detection rate of Clostridium in the case group was 43.14% (22/51), and the detection rate of Clostridium butyricum was the highest (19.61%, 10/51). There was a statistical difference between the two groups (χ2=5.85, P=0.015 58). All Clostridium strains did not carry the A, B and E type neurotoxin genes. Conclusion: Increased intestinal flora diversity, intestinal flora abundance and changes in the abundance of Clostridium may be closely related to the intestinal environment of children with NEC; Clostridium, especially Clostridium butyricum, may be related to the occurrence of NEC.
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Objective: To investigate the effect of Bifidobacterium on endothelial nitric oxide synthase and its potential protective mechanism in neonatal necrotizing enterocolitis using an induced mouse model. Methods: Sixty 8-day newborn C57BL/6 mice were randomized into three groups (n=20): control group, necrotizing enterocolitis group (NEC) and Bifidobacterium intervention group (NEC+BIF). Samples were collected 3 days after NEC modeling. HE staining pathological score was used to evaluate the modeling effect; the level of endothelial nitric oxide synthase (eNOS) in the intestine was detected with Western blotting; the eNOS activity, nitric oxide (NO) and superoxide (O2•) content were measured by Colorimetry. Real-time quantitative PCR was used to detect the mRNA level of interleukin-6 (IL-6) and interleukin-1β (IL-1β); the protein expression of IL-6 and IL-1β was assessed by ELISA. Results: No significant difference was observed in the protein levels of eNOS between the three groups. Compared with control group, in NEC group, the eNOS activity and NO content were significantly decreased; the O2 content was substantially increased; both IL-6 and IL-1β were dramatically increased (P0.05). Conclusion: Bifidobacterium can alleviate the severity of intestinal damage in NEC mouse model, the mechanism may be related to the enhancement of eNOS activity.
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Neonatal necrotizing enterocolitis (NEC) is one of common gastrointestinal critical diseases in the neonatal medical center,with high morbidity and mortality.The pathophysiological mechanism of the NEC is still unclear so far.Thus,the treatment of NEC is currently mainly limited to the symptomatic treatment in clinic.In the recent years,the studies on the pathogenesis of NEC have been increasing.This artical clarified the pathogenesis of NEC in six aspects:the pathogeny of intestinal immune function,gut microbiome,oxidative stress reaction,breastfeeding,blood transfusion and inflammatory mediators,to provide a new detection in prevention,diagnosis and treatment of NEC.
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Objective To investigate the protective effect of sodium butyrate on the neonatal mouse model of necrotizing enterocolitis and analyze its possible mechanism.Methods Sixty c57BL/6 neonatal mice were randomly divided into two groups (n=30):PBS group and butyric acid group.At the third day after birth,mice in both groups were respectively given PBS and sodium butyrate solution by gavage once a day for 7 days,and neonatal necrotizing enterocolitis (NEC) model was established by hypoxia,cold stimulation and artificial feeding.The newborn mice were sacrificed overnight after modeling.HE staining and double-blind pathological score were performed to observe the pathological changes of ileocecal intestinal tissue.The mRNA expressions of IL-6,IL-10,TGF-β1 and TNF-a were tested by quantitative real-time PCR.The levels of IL-10 and TGF-β1 in intestine tissues were evaluated using ELISA.Flow cytometry was used to analyze the ratio of regulatory T cells (Treg) on CD4+ T cells in both groups.Results When mice were sacrificed overnight after NEC modeling,the body weight was significantly higher in butyric acid group (4.50 ± 0.42g) than in PBS group (4.16 ± 0.60g,P＜0.05);No significant difference (P＞0.05) existed in survival rate of butyric acid group (76.34％) and PBS group (67.95％).The pathological damage score of intestinal tissue showed that the median score of intestinal injury was significantly lower in butyric acid group [1.33(1.33-1.67)] than in PBS group [2.00(1.67-2.25),P＜0.05].qPCR demonstrated that the expressions of IL-6 and TNF-α mRNA were obviously lower in butyric acid group than in PBS group (0.85 ± 0.30 vs.1.77 ± 0.49 and 0.41 ± 0.25 vs.0.96 ± 0.56,respectively,P＜0.05);and the expressions of IL-10 and TGF-β1 mRNA were markedly higher in butyric acid group than in PBS group (1.91 ± 0.82 vs.0.94 ± 0.43 and 1.46 ± 0.57 vs.0.88 ± 0.29,respectively,P＜0.05);Intestinal tissue ELISA results showed that the expressions of IL-10 and TGF-β1 were higher in butyric acid group than in PBS group (68.60 ± 15.06 vs.37.25 ± 5.81 and 424.93 ± 19.34 vs.127.31 ± 60.83,respectively,P＜0.05);Flow cytometry revealed that the proportion of regulatory T cells (Treg) of CD4+ T cells was higher in butyric acid group than in PBS group (12.68％ ± 6.79％ vs.3.57％ ± 0.88％,P＜0.05).Conclusions Butyric acid plays a protective effect in the intestinal injury of neonatal mouse model of necrotizing enterocolitis.The possible mechanism is that butyrate can down-regulate the expressions of cytokines IL-6 and TNF-o,up-regulate the expressions of cytokines IL-10 and TGF-β1,and promote the differentiation of T cells into Treg cells.
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Objective To observe the change of serum inflammatory factors such as tumor necrosis factor (TNF)-α, interleukin (IL)-6 before and after blood transfusion, and analyze the possible pathogenesis of transfusion-associated neonatal necrotizing enterocolitis (NEC). Methods One hundred and sixty-two patients who needed blood transfusion in NICU from Janury 2014 to Octorber 2015 were enrolled in this study. Among them, 13 patients had transfusion-ralated neonatal necrotizing enterocolitis (TRNEC, test group A), and 149 patients didn′t have TRNEC (test group B). In the mean time, 45 NEC patients without blood transfusion in 1 292 patients was as control group A, 30 patients who didn′t receive blood treatment and had NEC was as control group B. The levels of TNF-α, IL-6 in four groups were compared. Results The rate of TRNEC was 8.02% (13/162). The rate of NEC was 3.48%(45/1 292), and there was significant difference (χ2=7.79, P<0.01). The levels of serum TNF-α, IL-6 at 24 h and 48 h after blood transfusions in test group A and test group B were increased compared with those in control group B (P<0.01 or<0.05). The levels of serum TNF-α, IL-6 at 24 h and 48 h after blood transfusions in test group A were increased compared with those in test group B and control group A (P<0.01 or<0.05). The levels of serum TNF-α, IL-6 at 24 h and 48 h after blood transfusions in test group B were decreased compared with those in test group A (P<0.05). The levels of serum TNF-α, IL-6 at 24 h and 48 h after NEC in control group A were increased compared with those in control group B (P<0.05). Conclusions The pathogenesis of TRNEC may have connection with the inflammatory factors such as TNF-α, IL-6, which are produced in the processing of handling whole blood and the storage of red cell.
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Neonatal necrotizing enterocolitis (NEC) is a common acute abdomen in newborns.Premature infants,especially who have ever involved in infection or anoxia,are quite liable to NEC.NEC is likely to cause intestinal necrosis or intestinal perforation.As the neonatology develops,the survival rate of premature infant and very low birth weight(VLBW) improves too,which at the same time increases the incidence of NEC in newborns.The increasing early diagnosis rate of necrotizing enterocolitis,effective conservative or surgical treatments are saving more and more NEC infants,which also bring higher incidences of NEC complications.Enterostenosis is the most common complication of NEC patient who was given a conservative treatment,and its incidence is as high as 15％ ～ 57 ％.It is difficult to differentiate from feeding difficulties and gastroenteritis due to the lack of specific clinical manifestations in early enterostenosis,which makes the early diagnosis of enterostenosis seems difficult and missed diagnosis or misdiagnosis occurred.Enterostenosis may cause growth retardation,malnutrition or even severe consequences such as enterobrosis,sepsis or death.At present,enterostenosis of NEC has already attracted various medical workers 'attention.Basing on all of the above,our paper took a review on the progress of diagnosis and surgical treatments to enterostenosis.
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Neonatal necrotizing enterocolitis ( NEC) is a severe gastrointestinal disease with high mortality. Stud-ies have suggested that NEC are associated with prematurity and very?low birth weight, but the exact etiology and pathogen?esis has not been elucidated. Therefore, it is important to build an ideal NEC model to explore the pathogenesis and pre?vention measures of NEC to reduce the incidence and severity of NEC.
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Neonatal necrotizing enterocolitis (NEC)is a common gastrointestinal emergency,which belongs to one of the life-threatening diseases of neonatal infants.Its pathogenesises include premature birth,inappropriate feeding,intestinal infection and dysbacteriosis,hypoxic ischemic reperfusion injury,etc,which remain not fully known.The clinical stages,some severe complications such as respiratory failure and treatment etc,can affect the prognosis of neonatal infants with NEC.This article reviews the latest progress on related researches,which may provide clues to the early diagnosis,clinical observation and treatment of NEC.
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Neonatal necrotizing enterocolitis (NEC) is the most common neonatal gastrointestinal disease and has most lethal effect. In recent years,with the development of the neonatal intensive care unit,the survival rate of premature infants is increased, but the incidence rate of NEC is also increasing. At the present stage,the etiology of NEC is still not completely clear,which greatly limits the prevention and treatment of NEC. Risk factors including premature birth, infection, bacterial colonization, hypoxia ischemia,inflammatory reaction and enteral nutrition are summarized in this paper to provide basis for clinical diagnosis,treatment and prevention of NEC.
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Neonatal necrotizing enterocolitis (NEC) is still a disease with high mortality and morbidity in neonates.The pathogenesis of NEC is not quite clear.Inflammatory cascade,innate immune response and intestinal blood flow are thought to play significant roles in the machinism of NEC.Single nuleotide polymorhism (SNP) is characterized by single nucleotide mutation in the genecome consequences.They may alter the susceptibility to some kinds of diseases by changing the efficiency of transcription or the structure of protein coded by the related gene.This review summarizes the progress of the research on genetic polymorphisms in neonatal necrotizing enterocolitis.
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This article summarizes the high risk factors and the progress of prevention in neonatal necrotizing enterocolitis.It is beneficial for early intervention and reducing the morbidity and mortality of neonatal necrotizing enterocolitis.
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We reviewed surgical or autopsy specimens of the gastrointestinal tract from 14 patients with necrotizing enterocolitis(NEC) to define the specific pathologic findings and the pathologic changes of the bowel in the premature and fullterm infants, and then to see how these findings are related each other and to clinical features. In two-thirds of patients two or more continuous segments of the gastrointestinal tract were affected, and the ileum and colon were by far the most common sites of involvement. Pathologically, coagulation necrosis, inflammatory reaction, ulceration, microthrombi, overgrowth of microorganism, and perforation were the leading changes of NEC. On the basis of these histopathologic findings of the involving intestine, we could classify the pathology of NEC into two different histologic types. Type 1 and II are thought to represent pathologic changes of the intestine in acute and chronic stages of disease process. The symptom duration of the patients was significantly different between two types. The pathologic changes of the involved bowel were similar in both premature and fullterm infants, although the premature tended to have type 1 and the fullterm babies had more cases of type II. These pathologic changes could be associated with various clinical manifestation of NEC.
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Infant , Male , Female , Infant, Newborn , HumansABSTRACT
Group B. The pathological scores (x?s)for each gourp were group A:3.0?0.53,group B:3.63?0.52,group C:1.75?0.71,group D:1.75?0.46, group E:2.38?0.52 and group F 0.5?0.53 respectively. The score of group B had significant differences from those of other 5 groups (P