Preventive strategies and factors associated with surgically treated necrotising enterocolitis in extremely preterm infants: an international unit survey linked with retrospective cohort data analysis

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RESEARCH PRODUCT

Preventive strategies and factors associated with surgically treated necrotising enterocolitis in extremely preterm infants: an international unit survey linked with retrospective cohort data analysis

Adams Mark Dirk Bassler Darlow Brian A Lui Kei Reichman Brian Hakansson Stellan Norman Mikael Lee Shoo K Kjell Helenius Liisa Lehtonen Laura San Feliciano Vento Maximo Moroni Marco Beltempo Marc Yang Junmin Shah Prakesh S Rusconi Franca

subject

Data Analysis Male Pediatrics Internationality Databases Factual Infant Premature Diseases 2700 General Medicine paediatric gastroenterology Cohort Studies perinatology 0302 clinical medicine Risk Factors Cause of Death Surveys and Questionnaires Hospital Mortality 1506 030212 general & internal medicine Original Research Incidence (epidemiology)General Medicine Prognosis 3. Good health Primary Prevention Treatment Outcome Infant Extremely Premature Cohort Gestation Female 1719 Cohort study medicine.medical_specialty 610 Medicine & health neonatology Sepsis 03 medical and health sciences Enterocolitis Necrotizing Intensive Care Units Neonatal 030225 pediatrics Intensive care medicine Humans Neonatology Retrospective Studies business.industry Probiotics Infant Newborn Paediatrics Retrospective cohort study medicine.disease 10027 Clinic for Neonatology Survival Analysis digestive system diseases business

description

ObjectivesTo compare necrotising enterocolitis (NEC) prevention practices and NEC associated factors between units from eight countries of the International Network for Evaluation of Outcomes of Neonates, and to assess their association with surgical NEC rates.DesignProspective unit-level survey combined with retrospective cohort study.SettingNeonatal intensive care units in Australia/New Zealand, Canada, Finland, Israel, Spain, Sweden, Switzerland and Tuscany (Italy).PatientsExtremely preterm infants born between 240to 286weeks’ gestation, with birth weights<1500 g, and admitted between 2014–2015.ExposuresNEC prevention practices (probiotics, feeding, donor milk) using responses of an on-line pre-piloted questionnaire containing 10 questions and factors associated with NEC in literature (antenatal steroids, c-section, indomethacin treated patent ductus arteriosus and sepsis) using cohort data.Outcome measuresSurgical NEC rates and death following NEC using cohort data.ResultsThe survey response rate was 91% (153 units). Both probiotic provision and donor milk availability varied between 0%–100% among networks whereas feeding initiation and advancement rates were similar in most networks. The 9792 infants included in the cohort study to link survey results and cohort outcomes, revealed similar baseline characteristics but considerable differences in factors associated with NEC between networks. 397 (4.1%) neonates underwent NEC surgery, ranging from 2.4%–8.4% between networks. Standardised ratios for surgical NEC were lower for Australia/New Zealand, higher for Spain, and comparable for the remaining six networks.ConclusionsThe variation in implementation of NEC prevention practices and in factors associated with NEC in literature could not be associated with the variation in surgical NEC incidence. This corroborates the current lack of consensus surrounding the use of preventive strategies for NEC and emphasises the need for research.

year	journal	country	edition	language
2019-10-17

10.5167/uzh-177100 https://www.zora.uzh.ch/id/eprint/177100/