OBJECTIVES: To investigate the clinical characteristics and risk factors for early-onset necrotizing enterocolitis (NEC) in preterm infants with very/extremely low birth weight (VLBW/ELBW). METHODS: A retrospective analysis was performed on the medical data of 194 VLBW/ELBW preterm infants with NEC who were admitted to Children's Hospital Affiliated to Zhengzhou University from January 2014 to December 2021. These infants were divided into early-onset group (onset in the first two weeks of life; n=62) and late-onset group (onset two weeks after birth; n=132) based on their onset time. The two groups were compared in terms of perinatal conditions, clinical characteristics, laboratory examination results, and clinical outcomes. Sixty-two non-NEC infants with similar gestational age and birth weight who were hospitalized at the same period as these NEC preterm infants were selected as the control group. The risk factors for the development of early-onset NEC were identified using multivariate logistic regression analysis. RESULTS: Compared with the late-onset group, the early-onset group had significantly higher proportions of infants with 1-minute Apgar score ≤3, stage III NEC, surgical intervention, grade ≥3 intraventricular hemorrhage, apnea, and fever or hypothermia (P<0.05). The multivariate logistic regression analysis showed that feeding intolerance, blood culture-positive early-onset sepsis, severe anemia, and hemodynamically significant patent ductus arteriosus were independent risk factors for the development of early-onset NEC in VLBW/ELBW preterm infants (P<0.05). CONCLUSIONS VLBW/ELBW preterm infants with early-onset NEC have more severe conditions compared with those with late-onset NEC. Neonates with feeding intolerance, blood culture-positive early-onset sepsis, severe anemia, or hemodynamically significant patent ductus arteriosus have a higher risk of early-onset NEC.
Child ; Infant ; Female ; Pregnancy ; Infant, Newborn ; Humans ; Infant, Premature ; Infant, Extremely Low Birth Weight ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing/etiology* ; Retrospective Studies ; Infant, Newborn, Diseases ; Infant, Premature, Diseases/etiology* ; Risk Factors

OBJECTIVES: To study the effect of gut microbiota on hematopoiesis in a neonatal rat model of necrotizing enterocolitis (NEC). METHODS: Neonatal Sprague-Dawley rats were randomly divided into a control group and a model group (NEC group), with 6 rats in each group. Formula milk combined with hypoxia and cold stimulation was used to establish a neonatal rat model of NEC. Hematoxylin and eosin staining was used to observe the pathological changes of intestinal tissue and hematopoiesis-related organs. Routine blood tests were conducted for each group. Immunohistochemistry was used to observe the changes in specific cells in hematopoiesis-related organs. Flow cytometry was used to measure the changes in specific cells in bone marrow. 16S rDNA sequencing was used to observe the composition and abundance of gut microbiota. RESULTS: Compared with the control group, the NEC group had intestinal congestion and necrosis, damage, atrophy, and shedding of intestinal villi, and a significant increase in NEC histological score. Compared with the control group, the NEC group had significantly lower numbers of peripheral blood leukocytes and lymphocytes (P<0.05), nucleated cells in the spleen, thymus, and bone marrow, and small cell aggregates with basophilic nuclei in the liver (P<0.05). The NEC group had significant reductions in CD71⁺ erythroid progenitor cells in the liver, CD45⁺ lymphocytes in the spleen and bone marrow, CD3⁺ T lymphocytes in thymus, and the proportion of CD45⁺CD3^-CD43⁺SSC^hi neutrophils in bone marrow (P<0.05). There was a significant difference in the composition of gut microbiota between the NEC and control groups, and the NEC group had a significant reduction in the abundance of Ligilactobacillus and a significant increase in the abundance of Escherichia-Shigella (P<0.05), which replaced Ligilactobacillus and became the dominant flora. CONCLUSIONS Multi-lineage hematopoietic disorder may be observed in a neonatal rat model of NEC, which may be associated with gut microbiota dysbiosis and abnormal multiplication of the pathogenic bacteria Escherichia-Shigella.
Rats ; Animals ; Enterocolitis, Necrotizing/etiology* ; Gastrointestinal Microbiome ; Rats, Sprague-Dawley ; Animals, Newborn ; Infant, Newborn, Diseases

OBJECTIVES: To investigate the risk factors for necrotizing enterocolitis (NEC) in very preterm infants and establish a nomogram model for predicting the risk of NEC. METHODS: A total of 752 very preterm infants who were hospitalized from January 2015 to December 2021 were enrolled as subjects, among whom 654 were born in 2015-2020 (development set) and 98 were born in 2021 (validation set). According to the presence or absence of NEC, the development set was divided into two groups: NEC (n=77) and non-NEC (n=577). A multivariate logistic regression analysis was used to investigate the independent risk factors for NEC in very preterm infants. R software was used to plot the nomogram model. The nomogram model was then validated by the data of the validation set. The receiver operating characteristic (ROC) curve, the Hosmer-Lemeshow goodness-of-fit test, and the calibration curve were used to evaluate the performance of the nomogram model, and the clinical decision curve was used to assess the clinical practicability of the model. RESULTS: The multivariate logistic regression analysis showed that neonatal asphyxia, sepsis, shock, hypoalbuminemia, severe anemia, and formula feeding were independent risk factors for NEC in very preterm infants (P<0.05). The ROC curve of the development set had an area under the curve (AUC) of 0.833 (95%CI: 0.715-0.952), and the ROC curve of the validation set had an AUC of 0.826 (95%CI: 0.797-0.862), suggesting that the nomogram model had a good discriminatory ability. The calibration curve analysis and the Hosmer-Lemeshow goodness-of-fit test showed good accuracy and consistency between the predicted value of the model and the actual value. CONCLUSIONS Neonatal asphyxia, sepsis, shock, hypoalbuminemia, severe anemia, and formula feeding are independent risk factors for NEC in very preterm infant. The nomogram model based on the multivariate logistic regression analysis provides a quantitative, simple, and intuitive tool for early assessment of the development of NEC in very preterm infants in clinical practice.
Asphyxia/complications* ; Child ; Enterocolitis, Necrotizing/etiology* ; Female ; Fetal Growth Retardation ; Humans ; Hypoalbuminemia ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases ; Infant, Premature ; Infant, Premature, Diseases/etiology* ; Nomograms ; Sepsis/complications*

OBJECTIVE: To study the influence of premature rupture of membranes (PROM) on the early prognosis of extremely premature infants, and to provide a basis for the management of extremely premature infants and prenatal consultation. METHODS: A total of 179 extremely premature singleton infants who were born from 2017 to 2019 were enrolled. According to the presence or absence of PROM, they were divided into two groups: PROM group ( RESULTS: Compared with the non-PROM group, the PROM group had significantly higher incidence rates of earlyonset sepsis and necrotizing enterocolitis (NEC) ( CONCLUSIONS PROM increases the incidence rates of early-onset sepsis and NEC in extremely premature infants and does not increase the incidence rates of other adverse outcomes. For pregnant women with PROM at the risk of extremely preterm delivery, prevention of miscarriage and chorioamnionitis is recommended to prolong gestational weeks, reduce the incidence rate of infection, and thus improve the outcome of extremely premature infants.
Chorioamnionitis ; Enterocolitis, Necrotizing/etiology* ; Female ; Fetal Membranes, Premature Rupture/epidemiology* ; Gestational Age ; Humans ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Pregnancy ; Prognosis

A male infant, whose weight was 1 120 g at 28
Anemia ; Blood Transfusion ; Enterocolitis, Necrotizing/etiology* ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Male ; Premature Birth

OBJECTIVETo evaluate the relationship of vitamin D level with the development of necrotizing enterocolitis (NEC) in preterm infants.

METHODSA total of 429 preterm infants with a gestational age of <36 weeks, who were admitted to the department of neonatology within 2 hours after birth between January and December, 2016, were enrolled in the study. According to whether these infants developed NEC, the 429 subjects were divided into NEC group (n=22) and non-NEC group (n=407). Peripheral venous blood was collected from these preterm infants and their mothers at admission to measure the level of 25-hydroxyvitamin D (25-OHD). The two groups were compared in terms of the serum 25-OHD levels of preterm infants and their mothers. Pearson correlation analysis was used to investigate the correlation between the serum 25-OHD levels of preterm infants and their mothers. The distribution of vitamin D levels in preterm infants was compared between the two groups. The univariate logistic regression analysis was used to determine the risk factors for NEC in preterm infants.

RESULTSThe serum 25-OHD levels of preterm infants and their mothers in the NEC group were significantly lower than in the non-NEC group (P<0.001). In both groups, the serum 25-OHD levels of mothers and preterm infants were positively correlated with each other (P<0.001). The distribution of vitamin D levels (normal vitamin D level, low vitamin D level, vitamin D deficiency, and severe vitamin D deficiency) was significantly different between the NEC and non-NEC groups (P<0.001). The univariate logistic regression analysis showed that gestational age, birth weight, 25-OHD levels of preterm infants and their mothers, the duration of mechanical ventilation, the duration of oxygen inhalation, and the length of hospital stay were associated with the development of NEC (P<0.05).

CONCLUSIONSThe serum 25-OHD levels of preterm infants and their mothers may be related to the development of NEC in preterm infants, suggesting that vitamin D supplementation during pregnancy is important for preventing the development of NEC in preterm infants.

Enterocolitis, Necrotizing ; etiology ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; etiology ; Logistic Models ; Male ; Vitamin D ; analogs & derivatives ; blood ; Vitamin D Deficiency ; complications

OBJECTIVETo investigate the importance of breastfeeding in preterm infants with various gestational ages.

METHODSA total of 639 preterm infants with a gestational age of 28-36weeks were enrolled, and according to the feeding pattern, they were divided into exclusive breastfeeding group (n=237) and formula milk feeding group (fed with liquid milk for preterm infants; n=402). These two feeding patterns were compared in terms of their effects on weight gain, laboratory markers including albumin (Alb) and alkaline phosphatase (ALP), incidence rate of feeding intolerance, and incidence rates of complications including necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP).

RESULTSCompared with the formula milk feeding group, the breastfeeding group had a significantly faster increase in body weight, a significantly lower incidence rate of NEC, a significantly higher ALP level, and a significantly lower Alb level in the preterm infants with a gestational age of 28-30 weeks (P<0.05); there were no significant differences between the two groups in the incidence rates of anemia, ROP, bronchopulmonary dysplasia (BPD), and nosocomial infection and length of hospital stay (P>0.05). For the preterm infants with a gestational age of 31-33 weeks, the breastfeeding group had a significantly faster increase in body weight, a significantly lower incidence rate of feeding intolerance, a significantly shorter length of hospital stay, and a significantly higher ALP level (P<0.05); there were no significant differences between the two groups in the incidence rates of NEC, anemia, ROP, BPD, and nosocomial infection and the Alb level (P>0.05). For the preterm infants with a gestational age of 34-36 weeks, there were no significant differences in these indices between the two groups (P>0.05).

CONCLUSIONSBreastfeeding plays an important role in increasing body weight, reducing the incidence rates of feeding intolerance and NEC, and shortening the length of hospital stay in preterm infants with a gestational age of 28-33 weeks.

Breast Feeding ; Bronchopulmonary Dysplasia ; etiology ; Enterocolitis, Necrotizing ; etiology ; Humans ; Infant Formula ; Infant, Newborn ; Infant, Premature ; Intensive Care Units, Neonatal ; Retinopathy of Prematurity ; etiology

OBJECTIVETo investigate the risk factors for concurrent sepsis in neonates with necrotizing enterocolitis (NEC).

METHODSA retrospective analysis was performed for the clinical data of 273 neonates with NEC. The risk factors for concurrent sepsis were analyzed from the aspects of perinatal factors and treatment regimen before the diagnosis of NEC.

RESULTSThe incidence rate of concurrent sepsis in NEC was 32.2% (88/273). The neonates with stage III NEC had a significantly higher incidence rate of concurrent sepsis than those with stage II NEC (69.0% vs 15.9%; P<0.05). Of all neonates with sepsis, 62.5% experienced sepsis within 3 days after the diagnosis of NEC, and 37.5% experienced sepsis more than 3 days after the diagnosis. Compared with those without concurrent sepsis, the neonates with concurrent sepsis had significantly lower gestational age and birth weight (P<0.05). The neonates who had scleredema, had stage III NEC, needed gastrointestinal decompression after the diagnosis of NEC, and experienced a long time of gastrointestinal decompression tended to develop sepsis more easily (P<0.05). Scleredema (OR=9.75, 95%CI: 2.84-33.52, P<0.001), stage III NEC (OR=12.94, 95%CI : 6.82-24.55, P<0.001), and gastrointestinal decompression (OR=2.27, 95%CI: 1.14-4.5, P=0.02) were independent risk factors for concurrent sepsis in NEC.

CONCLUSIONSScleredema, stage III NEC, and gastrointestinal decompression are independent risk factors for concurrent sepsis in neonates with NEC.

Enterocolitis, Necrotizing ; complications ; Humans ; Infant, Newborn ; Retrospective Studies ; Risk Factors ; Sepsis ; etiology

Breastfeeding is well-known for its benefits of preventing communicable and non-communicable diseases. Human breastmilk consists not only of nutrients, but also of bioactive substances. What's more, the epigenetic effects of human breast milk may also play an important role. Alterations in the epigenetic regulation of genes may lead to profound changes in phenotype. Clarifying the role of human breast milk on genetic expression can potentially benefit the infant's health and his later life. This review article makes a brief summary of the epigenetic mechanism of breast milk, and its epigenetic effects on neonatal necrotizing enterocolitis, infectious diseases, metabolism syndrome, cognitive function and anaphylactic diseases.
Breast Feeding ; Cognition ; Communicable Diseases ; etiology ; genetics ; Enterocolitis, Necrotizing ; etiology ; genetics ; Epigenesis, Genetic ; Female ; Humans ; Hypersensitivity ; etiology ; genetics ; Infant, Newborn ; Metabolic Syndrome ; etiology ; genetics

OBJECTIVETo explore an optimal oxygen saturation for extremely preterm infants based on a systemic review of the published studies.

METHODSA Meta analysis of the published studies by the NeOProM Group which compared the outcomes of extremely preterm infants (gestational age <28 weeks) maintained in either a low (85%-89%) or high (91%-95%) oxygen saturation (SpO2) by using the STATA 12.0. The outcomes measured included the mortality and the incidences of retinopathy of prematurity (ROP), necrotizing enterocolitis of newborn (NEC), broncho-pulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) and patent ductus arteriosus (PDA).

RESULTSThree studies were included, in which 2 460 infants were assigned into the low SpO2 group and 2 459 infants in the high SpO2 group. The Meta analysis demonstrated that the risk of mortality before discharge or at the age of 18 months increased in the low SpO2 group compared with the high SpO2 group (RR: 1.19; 95%CI: 1.05-1.35); the risk of ROP decreased in the low SpO2 group (RR: 0.73; 95%CI: 0.53-1.00); the risk of NEC increased in the low SpO2 group (RR: 1.26; 95%CI: 1.06-1.49). There was no significance in the incidences of BPD, IVH and PDA between the two groups.

CONCLUSIONSMaintaining SpO2 at 85%-89% may decrease the incidence of ROP, but increase the mortality rate and the incidence of NEC in extremely premature infants.

Enterocolitis, Necrotizing ; etiology ; Humans ; Infant ; Infant Mortality ; Infant, Extremely Premature ; metabolism ; Outcome Assessment (Health Care) ; Oxygen ; blood ; Retinopathy of Prematurity ; etiology