Document Detail


Prevention of necrotizing enterocolitis in preterm infants: a 20-year experience.
MedLine Citation:
PMID:  17145901     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Diet, indomethacin, and early use of dexamethasone have been implicated as possible causes of necrotizing enterocolitis and intestinal perforation. Because we seldom prescribe indomethacin or early dexamethasone therapy and we follow a special dietary regimen that provides late-onset, slow, continuous drip enteral feeding, we reviewed our 20 years of experience for the incidence of necrotizing enterocolitis and bowel perforation. METHODS: We reviewed data on all 1239 very low birth weight infants (501-1500 g) admitted to our level III unit over a period of 20 years (1986-2005), for morphologic parameters, necrotizing enterocolitis, bowel perforation, use of the late-onset, slow, continuous drip protocol, and indomethacin therapy. Outcome data were also compared with Vermont Oxford Network data for the last 4 years. RESULTS: In 20 years, 1158 infants received the late-onset, slow, continuous drip feeding protocol (group I), whereas 81 infants had either a change in dietary regimen, use of indomethacin, or early use of dexamethasone (group II). The rate of necrotizing enterocolitis in group I of 0.4% was significantly lower than that in group II of 6%. Group I, in comparison with the Vermont Oxford Network, had significantly lower rates of necrotizing enterocolitis (0.4% vs 5.9%), surgical necrotizing enterocolitis (0.4% vs 3.1%), and bowel perforation (0.35% vs 2.2%). CONCLUSIONS: Our 20-year experience with 1239 very low birth weight infants suggests strongly that the late-onset, slow, continuous drip feeding protocol and avoidance of indomethacin and early dexamethasone treatment contribute to the prevention of necrotizing enterocolitis.
Authors:
Jeff Pietz; Babu Achanti; Lawrence Lilien; Erin Clifford Stepka; Sudhir Ken Mehta
Publication Detail:
Type:  Journal Article     Date:  2006-12-04
Journal Detail:
Title:  Pediatrics     Volume:  119     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-01-03     Completed Date:  2007-01-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e164-70     Citation Subset:  AIM; IM    
Affiliation:
Neonatal Division, Department of Pediatrics, Fairview Hospital, Cleveland Clinic Health System, Cleveland, Ohio 44111-5656, USA. jeff_pietz@pediatrix.com
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MeSH Terms
Descriptor/Qualifier:
Dexamethasone / adverse effects,  therapeutic use
Enterocolitis, Necrotizing / etiology,  prevention & control*
Feeding Methods
Female
Humans
Indomethacin / adverse effects,  therapeutic use
Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Premature, Diseases / etiology,  prevention & control*
Infant, Very Low Birth Weight*
Intestinal Perforation / etiology,  prevention & control
Male
Chemical
Reg. No./Substance:
50-02-2/Dexamethasone; 53-86-1/Indomethacin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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