جستجوی مقالات مرتبط با کلیدواژه « enterocolitis » در نشریات گروه « پزشکی »

There are several studies regarding perforations after intravenous immunoglobulin (IVIG) infusion; however, the risk factors are not defined yet.

The present study aimed to investigate gastrointestinal complications in newborns regarding the reported immunoglobulin A (IgA) levels in IVIG preparations.

This retrospective chart review was conducted on term newborns who received IVIG therapy in two centers in Istanbul. The study included patients with IVIG-associated gastrointestinal bleedings, necrotizing enterocolitis (NEC), and intraabdominal perforations without any underlying diseases and recorded demographic data (gestational age, birth weight, and gender) and the IgA levels in the IVIG preparations. Infants born below 35 gestational weeks were excluded as they were more likely to have NEC.

A total of 71 patients received IVIG therapy, and 15.5% (n = 11) developed major gastrointestinal system (GIS) complications. A total of 36 patients were born ≥ 35 gestational weeks, and gastrointestinal perforation or bleeding occurred in 22.2% (n = 8) of these patients. Two patients died before surgery due to aggressive disease progression. None of these patients had any gastrointestinal symptoms before IVIG therapy or any predisposing factors for gastrointestinal perforation. All patients were on spontaneous breathing and enteral feeding without intolerance. The IgA level content of the IVIG preparations was related to the major GIS complications with strong evidence, and the safe threshold resulted in 14 mg/dL in receiver operating characteristic (ROC) analysis in the present study group.

Higher IgA levels in IVIG preparations might be a risk factor for gastrointestinal perforation and bleeding in term newborns. Clinicians should be aware of this potential complication when using IVIG therapy in term newborns and closely monitor for signs and symptoms of major gastrointestinal complications.

Shellfish is defined as any edible marine invertebrate and refers to crustaceans and mollusks. Crustaceans belong to the phylum Arthropods. Mollusks belong to the phylum Mollusca. This report illustrates a rare case of a 6-year-old girl with challenge-proven acute food protein–induced enterocolitis syndrome (FPIES) to cuttlefish (phylum Mollusca, class Cephalopoda), anaphylaxis to crustaceans (phylum Arthropoda), and tolerance to other mollusks, including clams and mussels (phylum Mollusca, class Bivalvia). The association of IgE-mediated food allergy and acute FPIES seen in this case is rare.

To our knowledge, this is the first case of FPIES to cuttlefish reported in a child. This challenge highlights the need for further research into the allergens and mechanisms underpinning FPIES at a molecular level, enabling a better understanding of cross-reactivity patterns and the development of diagnostic and predictive tests to assist in clinical practice.

Context:

 Necrotizing enterocolitis (NEC), as a life-threatening gastrointestinal tract disease, is associated with high rates of morbidity and mortality. Extensive inflammation, progressive hemorrhagic necrosis, and overwhelming infection of the gut are reasons why NEC is known as a devastating disease in premature infants. Almost 45% of affected preterm infants die, and those who survive suffer from multiple complications. Human milk, the best food for newborns, plays a significant role in supporting the immune system. Both mother’s own milk (MOM) and donor human milk (DHM) are particularly important in the prevention and lessening of the severity of NEC. Evidence Acquisition: We searched PubMed, Elsevier, and Google Scholar databases for articles that investigated the correlation between NEC and human milk. Then all data were accessed about their relevancy to this current subject.

In summary, the purpose of this article is to firstly review the protective role of breast milk components against NEC, and secondly discussing the correlation between human milk and NEC in clinical studies. Human milk bio-components, including Lactoferrin, oligosaccharides, maternal soluble IgA, epidermal growth factor, transforming growth factor, prebiotic, probiotics, and antioxidants, have a protective effect against NEC. However, the importance of these components in donor human milk and the formula is underestimated.

Human milk, as the first-choice of nutritional source, comprises a wide diversity of copious bio-components, which dwindle the risk and severity of NEC in many ways. The exact mechanisms are still unclear, the evidence strongly point out that human milk is superior to any other nutrition concerning protecting the gastrointestinal tract from NEC.

Avoiding hyperoxia with oxygen saturation monitoring is important in the follow‑up of very low birth weight (VLBW) infants. Role of oxygen‑derived free radicals in the pathogenesis of necrotizing enterocolitis (NEC) has been well defined. However, a great majority of the evidence supporting the role of hyperoxia in NEC development are data from experimental studies and there are very few clinical studies. In this study, the association between NEC and average oxygen saturation (SpO2) levels in VLBW infants was researched.

Average SpO2 values of VLBW infants in the last 24 h were recorded prospectively with pulse oximeter. Average SpO2 records were continued at least for 10 days starting from the first day after birth. In the follow‑up, the average SpO2 values of the patients who developed NEC and those who did not were compared.

A total of 127 VLBW infants were followed up. Thirteen patients developed NEC (Bell’s classification ≥ stage II). No differences were found between the average SpO2 levels (94.9 and 94.8%) of the patients who developed NEC and those who did not. It was found that average SpO2 value higher than 93 or 95 was not a risk for NEC development (P = 0.693 and P = 0.771).

In this study, no association was found between average SpO2 values recorded in the first weeks of VLBW infants and NEC.

Gastrointestinal (GI) dysmotility is a common problem among preterm neonates with very-low-birth-weight and is manifested as feeding intolerance, and in this situation, total parenteral nutrition (TPN) is needed for several complications. Erythromycin is a prokinetic antibiotic that neonatologists widely prescribe for the treatment of GI dysmotility in high and low doses.

This study aimed to evaluate the effects of an intermediate dose of Erythromycin in the treatment of feeding intolerance in preterm neonates.

This study is a randomized clinical trial on preterm neonates admitted in two university-affiliated hospitals in Isfahan, Iran, during 2016 - 2017. Feeding is started for all neonates with 20 mL/kg/day doses and if they tolerate it, 20 mL/kg/day is added daily to receive toreach 150 mLcc/kg/day. The infants were divided into two groups, which received either Erythromycin (5 mg/kg/dose every 6 hours) or placebo for eight days. These outcomes were evaluated: time duration to reach 75, 110, and 150 mL/kg/day feeding volume, lavage count after the intervention, time duration of oxygen dependency and hospitalization, the incidence of necrotizing enterocolitis, intraventricular hemorrhage, patent ductus arteriosus, chronic lung disease, cholestatic icterus, sepsis, and hypertrophic pyloric stenosis.

Sixty-four neonates (female 38 (59.3%) and male 26 (40.6%)) with the mean gestational age 30.10 ± 2.49 weeks were evaluated. The mean time duration to reach 75, 110, and 150 mL/kg/day feeding volume was significantly lower in the Erythromycin group (4.19 vs. 6.84 days, P < 0.001, 6.35 vs. 9.08 days, P < 0.001 and 9 vs. 11.46 days, P < 0.001 in the Erythromycin vs. placebo groups, respectively). Also the number of lavages were significantly lower in the Erythromycin group (0.35 ± 0.56 vs. 3.03 ± 3.08 in the Eerythromycin and placebo groups; P < 0.001).

Intermediate dose of Erythromycin can reduce the time duration to reach full feeding volume and is safe for preterm neonates.

The clinical presentation of appendicitis in the newborn is nonspecific. The diagnosis was always made after surgical exploration for acute abdominal findings mimicking necrotizing enterocolitis. We report the case of acute appendicitis in a newborn diagnosed intraoperatively after neonatal occlusion symptoms.

Clostridium difficile is the most important anaerobic, gram positive, spore forming bacillus which is known as a prevalent factor leading to hospital diarrheas and is the causative agent of pseudomembrane colitis. The role of this bacteria along with the over use of antibiotics have been proved to result in colitis. The major virulence factors of these bacteria are the A and B toxins.. The purpose of this study was to isolate C. difficile from stool samples and detect A and B toxins encoding genes, in order to serve as a routine method for clinical diagnosis.. Recognition of A and B toxins encoding genes by uniplex and multiplex PCR using two pairs of primers from 136 accumulated stool samples.. Results of the present study showed that out of 136 stool samples, three C. difficile were isolated and these strains contained A and B toxins encoding genes.. It wasconcluded that although detection of C. difficile from stool samples based on PCR (polymerase chain reaction) is expensive, yet this method is more sensitive and less time-consuming than culture methods and can be used as a clinical laboratory test..

Dear Editor,.The study by Dashti et al. is a single center double-blinded placebo controlled trial that exposed infants ≤ 1800 grams in the intervention group to a multi-species preparation of probiotics. The authors of this paper did not find a difference in the incidence of necrotizing enterocolitis (NEC) between the intervention and the placebo group, nor did they find a difference in any of their secondary outcomes. The paper does not describe the incidence of NEC in their institution and they do not describe how they calculated the sample size based on their historical incidence of NEC. I believe this to be the main weakness of this study and the major reason why the authors of this paper were not powered to find a difference in the primary outcome if in fact this difference did exist. Using the control group incidence of NEC of 1.49% (stage II and III Bell’s classification), a confidence level of 95%, a power of 80% and an expected decrease of 50% in the incidence rate of NEC (to 0.75%), the total sample size required for this study would have been 6,876 infants (3,438 infants in each group). Another possible explanation for the observed lack of efficacy may be due to the inclusion of infants > 1500 grams, a group that traditionally has a much lower incidence of NEC compared to infants born at ≤ 1500 grams. Recruitment of this proportionally large number of more mature infants would tend to dilute the effect of the intervention. Also, the late administration of the probiotic preparation (mean age 4.36 days) when colonization with potential NICU pathogens may already be established could also add to the observed lack of efficacy. The main weaknesses highlighted in this study are not unique to this study but a major theme of the majority of studies included in the multiple meta-analyses published on the use of Probiotics in preterm infants (1-5). Although these meta-analyses have shown a decrease in the incidence of NEC with the use of different species of probiotics, the potential for publication and selection bias is of great concern because of the known tendency for journals to reject studies that do not show efficacy. From this perspective, I welcome Archives of Pediatric Infectious Diseases’s decision to publish this manuscript. Also, the poor quality of the design of many of the studies included in these meta-analyses makes their conclusions at the very least suspicious. Are we ready to start using probiotics for the prevention of NEC in premature infants? Although we understand the urgency of finding an intervention that prevents NEC due to the high mortality and morbidity associated with this outcome, wisdom dictates a more thorough evaluation of the bio-molecular characteristics of specific species, their dosing, quality, and safety. This is especially relevant in the extremely premature infant population where some published studies have demonstrated a higher incidence of sepsis when exposed to probiotics (6, 7). I do not believe that we have at the present time a probiotic species that fulfills all these basic requirements. An international consensus agreement that prioritizes and directs future efforts in this area of research is urgently needed to expedite fulfilling these goals. This fragile population of premature infants embraces and supports our coordinated efforts.

Dear Editor,Science involves controversy, conflicting results and thoughtful analysis. Clinical trials finding a significant efficacy for a new investigational therapy require confirmatory trials, but often subsequent trials result in a negative finding (equivalence or non-significant efficacy). These negative trials are important and, in the past, have had trouble getting published. Publication bias is common, as studies showing a significant efficacy are typically published, while negative studies have been largely ignored. While this trend is slowly reversing, the onerous task for authors in overcoming this bias necessities a higher burden for quality writing and more detailed analysis than required for studies with significant positive findings. It is imperative that scientists explore all the possible explanations for the finding of non-significance efficacy. It may be that the investigated therapy is truly not effective, but it also may be due to insufficient power due to small study size, or the choice of a low dose, or differential attrition, or other types of bias.The field of probiotics for the treatment and prevention of various diseases is replete with both positive (showing significant therapeutic effect) and negative (showing equivalence or non-significant results) clinical trials. This is not surprising, as the efficacy of probiotics is both strain-specific and disease-specific. Not all probiotic strains work for all diseases or even within one disease indication. A recent paper by Dashti et al. in this journal reports finding no significant difference in the incidence of necrotizing entercolitis (NEC) in neonates treated with a probiotic mixture compared to placebo (1).NEC is an important cause of morbidity and mortality in low birth weight neonates and currently there are no modalities to prevent NEC from occurring. The use of probiotics has been suggested by a recent significant finding of pooled efficacy for NEC from 11 randomized trials in a meta-analysis by Deshpande et al. (2). Dashti et al. tested a probiotic mixture of eight bacterial strains, but did not find a significant reduction in NEC when compared to their control group (1). However, when we try to place this result into context, it is difficult to determine why or how this result may have occurred. The authors in this paper failed to provide readers with sufficient details on the study to fully assess the reasons why they did not find a significant efficacy of this probiotic mixture to prevent NEC. The major limitation is that the authors fail to present the identity of the two groups (designated “Group A” and “Group B”), so it is impossible to determine which is the group treated with the probiotic and which is the control group. Blinding a trial is commendable during its operation, but maintaining the blinding when presenting the results is counterproductive.The recommended use of a CONSORT figure would have provided valuable insight into the numbers of infants screened versus number enrolled. No presentation of the rates and reasons for attrition were presented, so it cannot be determined if loss-to-follow-up may have played a role in the negative results. Another common reason for negative efficacy findings in that the trial is too small and lacks the power to detect a significant difference. The authors did not report if they calculated the required sample size in the methods sections, indeed, the power of this study is extremely low (only 4%).Careful description of the investigational treatment is paramount in clinical trials. The investigational mixture was not fully described (missing bacterial strain for one of the Bifidobacterium strains) and the authors failed to indicate that this product contains 990 mg of a prebiotic (FOS) per sachet.The authors discuss some possible reasons for their negative findings (low dose, low rate of NEC or the lack of efficacy of the tested probiotic product). Low dose may be an explanation, in that the neonates most at risk (birth weight < 1500 mg) only received 108 organisms/d and most trials in neonates (BW < 1500 g) at risk for NEC have received a daily dose of 109/d (2). It would have been useful for the authors to present the rate of NEC by the two groups, stratified on birthweight, as 43% of the enrolled neonates were not at high risk for NEC (birthweight > 1500 g). Their rate of NEC is not low (12-14%) compared to other studies (1-10% in various probiotic groups and 6-16% in control groups) (3-5).In conclusion, the results reported by Dashti et al. may not have found a significant efficacy for this specific probiotic mixture in preventing NEC, but insufficient study methods and data presentation limits the interpretation of their data. This study exemplifies the requirement for a higher burden of analysis for possible reasons for non-significant findings.

Probiotics are thought to interfere with the mechanisms involving in the pathogenesis of necrotizing enterocolitis in neonates.. This study was planned to assess the effect of prophylactic probiotics for the prevention of necrotizing enterocolitis in low birth weight neonates..Patients and This prospective triple-blinded, interventional, randomized clinical trial enrolled 136 low birth weight newborn infants with a minimum birth weight of 700 g, from September 2010 to September 2011. The study and control groups were compared regarding; 1- occurrence of NEC, 2- time to reach full feeding, defined as days required to reach full enteral feeding, 3- duration of hospital course, and 4-incidence of sepsis and death. The study group was fed with milk and Protexin (restore) and the control group was fed with milk and a placebo that was physically indistinguishable from the probiotic powder. SPSS version 16 was used, and P-value less than 0.05 was considered significant.. One hundred thirty six neonates were enrolled in the study. Seventy six (54.4%) were male. The mean of gestational age and birth weight were 31 weeks and 1407 grams, respectively. The mean age to start feeding was 4.36 days. There was not any significant difference in the NEC cases between the two groups.. This study did not show any benefit from prophylactic probiotics in the prevention of necrotizing enterocolitis in low birth weight neonates which could be probably due to low dose probiotics used..