Necrotizing Enterocolitis RiskState

Necrotizing Enterocolitis Risk
State of the Science
Ms Sheila M. Gephart, RN, BSN, Dr Jacqueline M. McGrath, PhD, RN, Dr Judith A. Effken, PhD, RN, and Dr Melissa D. Halpern, PhD
Author information ► Copyright and License information ►
The publisher's final edited version of this article is available at Adv Neonatal Care
See other articles in PMC that cite the published article.
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Abstract

Necrotizing enterocolitis (NEC) is the most common cause of gastrointestinal-related morbidity and mortality in the neonatal intensive care unit (NICU). Its onset is sudden and the smallest, most premature infants are the most vulnerable. Necrotizing enterocolitis is a costly disease, accounting for nearly 20% of NICU costs annually. Necrotizing enterocolitis survivors requiring surgery often stay in the NICU more than 90 days and are among those most likely to stay more than 6 months. Significant variations exist in the incidence across regions and units. Although the only consistent independent predictors for NEC remain prematurity and formula feeding, others exist that could increase risk when combined. Awareness of NEC risk factors and adopting practices to reduce NEC risk, including human milk feeding, the use of feeding guidelines, and probiotics, have been shown to reduce the incidence of NEC. The purpose of this review is to examine the state of the science on NEC risk factors and make recommendations for practice and research.
Keywords: necrotizing enterocolitis, neonatal, nursing, risk assessment, risk profile

Necrotizing enterocolitis (NEC) is the most common and frequently dangerous gastrointestinal emergency in premature infants in the neonatal intensive care unit (NICU).1 Although 90% of infants who develop NEC are born premature, full-term and near-term infants also develop the disease.2 Modern technology and advances in clinical care have improved our ability to sustain and support infants born prematurely, but the prevalence of NEC has not decreased.2,3 It is estimated that nearly 12% of infants born weighing less than 1500 g will develop NEC; of those, about 30% will not survive.2,3

The incidence of NEC is inversely related to an infant’s birth gestation, but marked variability is evident across NICUs and countries.4–6 Because outbreaks continue to occur, the Centers for Disease Control and Prevention recommends that hospitals consider maintaining surveillance for NEC like they do for other nosocomial infections.7,8 The economic cost of NEC is high, accounting for approximately 19% of neonatal expenditures and an estimated $5 billion per year for hospitalizations in the United States alone.9 If the disease can be managed medically, the cost of hospitalization has been estimated at around $73 700 with a length of stay exceeding on average 22 days more than that for other premature infants. However, if surgical care is required, there is at least an additional cost of $186 200, and infants stay an additional 60 days longer than other preterm infants.9

Necrotizing enterocolitis is a multifactorial illness with a poorly understood pathogenesis.1–5 The most important risk factor for NEC is prematurity and the earliest infants are at the greatest risk. Multiple factors, including hypoxia, feeding, sepsis, abnormal colonization of the bowel, and the release of inflammatory mediators stimulated by an ischemic-reperfusion injury in an immature gut, are thought to lead to NEC.2,5 An inflammatory cascade is thought to precipitate NEC as tumor necrosis factor α and platelet-activating factor work synergistically to contribute to mucosal damage in NEC. Yet, this inflammatory cascade is thought to be set off by an inciting event or chain of events. Such events may include hypoxia in utero or sepsis. The release of inflammatory mediators signals neutrophil activation, increased permeability of the vasculature, release of reactive oxygen species, and ultimately vasoconstriction with ischemic-reperfusion injury.2,5 As the mucosal barrier breaks down and NEC becomes severe, it can lead to overwhelming sepsis and death in the worst cases.2,5

Understanding how the combined occurrence of risk factors may lead to the chain of events setting the stage for NEC may lead to heightened vigilance to detect the early symptoms of NEC.5,6 The purpose of this article is to describe and critique the state of the science on NEC risk factors in the context of gestation, feeding practices, and pathophysiology. Preventive treatments will also be discussed. Risk factors will be discussed related to their time of occurrence: before birth (prenatal), during the labor and delivery process (intrapartum), or as part of the clinical course (clinical course factors). This evidence will be used to develop a clinical profile of the infant most at risk to develop NEC.
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Review of the Literature

A comprehensive review of literature using the databases PubMed, CINAHL, EBSCO, and Web of Science was conducted using the key words “necrotizi

ผลลัพธ์ (อังกฤษ) 2:

Necrotizing enterocolitis Risk
State of the Science
Ms Sheila M. Gephart, RN, BSN, Dr Jacqueline M. McGrath, PhD, RN, Dr Judith A. Effken, PhD, RN, and Dr Melissa D. Halpern, PhD
Author information ► Copyright and. License information ►
The Publisher's edited Final Version of this Article is available at Adv Neonatal Care
See Other articles in PMC that the Cite Published Article.
Go to:
Abstract

necrotizing enterocolitis (NEC) is the Cause of Most common gastrointestinal-related morbidity and mortality in the Neonatal intensive Care UNIT (NICU). Its onset is sudden and the smallest, most premature infants are the most vulnerable. Necrotizing enterocolitis is a costly disease, accounting for nearly 20% of NICU costs annually. Necrotizing enterocolitis survivors requiring surgery often stay in the NICU more than 90 days and are among those most likely to stay more than 6 months. Significant variations exist in the incidence across regions and units. Although the only consistent independent predictors for NEC remain prematurity and formula feeding, others exist that could increase risk when combined. Awareness of NEC risk factors and adopting practices to reduce NEC risk, including human milk feeding, the use of feeding guidelines, and probiotics, have been shown to reduce the incidence of NEC. The purpose of this review is to examine the state of the science on NEC risk factors and make recommendations for practice and research.
Keywords: necrotizing enterocolitis, Neonatal, Nursing, risk Assessment, risk Profile

necrotizing enterocolitis (NEC) is the Most Frequently Dangerous and common in premature Infants in the Neonatal Emergency gastrointestinal intensive Care UNIT (NICU) .1 Although 90% of Infants Who Develop NEC. are born premature, full-term and near-term infants also develop the disease.2 Modern technology and advances in clinical care have improved our ability to sustain and support infants born prematurely, but the prevalence of NEC has not decreased.2,3 It. is estimated that nearly 12% of infants born weighing less than 1500 g will develop NEC; of those, 30% Will not Survive.2,3 About

The incidence of NEC is inversely related to an Infant's birth gestation, but marked variability is evident Across NICUs and Countries.4-6 Because Outbreaks Continue to occur, the Centers for Disease Control. and Prevention recommends that hospitals consider maintaining surveillance for NEC like they do for other nosocomial infections.7,8 The economic cost of NEC is high, accounting for approximately 19% of neonatal expenditures and an estimated $ 5 billion per year for hospitalizations in the United States. alone.9 If the disease can be managed medically, the cost of hospitalization has been estimated at around $ 73 700 with a length of stay exceeding on average 22 days more than that for other premature infants. However, if surgical Care is required, there is an additional cost of at Least $ 186 200, and an additional 60 days Infants Stay Longer than Other preterm Infants.9

necrotizing enterocolitis is a multifactorial illness with a poorly understood Pathogenesis.1-5 The Most. important risk factor for NEC is prematurity and the earliest infants are at the greatest risk. Multiple factors, including hypoxia, feeding, sepsis, abnormal colonization of the bowel, and the release of inflammatory mediators stimulated by an ischemic-reperfusion injury in an immature gut, are thought to lead to NEC.2,5 An inflammatory cascade is thought to. precipitate NEC as tumor necrosis factor α and platelet-activating factor work synergistically to contribute to mucosal damage in NEC. Yet, this inflammatory cascade is thought to be set off by an inciting event or chain of events. Such events may include hypoxia in utero or sepsis. The release of inflammatory mediators signals neutrophil activation, increased permeability of the vasculature, release of reactive oxygen species, and ultimately vasoconstriction with ischemic-reperfusion injury.2,5 As the mucosal barrier breaks down and NEC becomes severe, it can lead to overwhelming sepsis. and Death in the worst Cases.2,5

Understanding How the combined occurrence of risk factors May Lead to the chain of events Setting the Stage for NEC May Lead to Early heightened vigilance to detect the symptoms of NEC.5,6 The purpose of this. article is to describe and critique the state of the science on NEC risk factors in the context of gestation, feeding practices, and pathophysiology. Preventive treatments will also be discussed. Risk factors will be discussed related to their time of occurrence: before birth (prenatal), during the labor and delivery process (intrapartum), or as part of the clinical course (clinical course factors). This evidence will be used to develop a clinical profile of the infant most at risk to develop NEC.
Go to:
Review of the Literature

A Comprehensive review of literature using the databases PubMed, CINAHL, EBSCO, and Web of Science was conducted using the Key Words "Necrotizi.

ผลลัพธ์ (อังกฤษ) 3:

Necrotizing Enterocolitis Risk.State of the Science.Ms Sheila M. Gephart RN BSN Dr Jacqueline,,,,, M. McGrath PhD RN Dr Judith, A. Effken PhD RN,,,, and Dr Melissa D. Halpern. PhD.Author information goes Copyright and License information goes.The publisher 's final edited version of this article is available at Adv Neonatal Care.See other articles in PMC that cite the published article.Go to:Abstract.Necrotizing enterocolitis (NEC) is the most common cause of gastrointestinal-related morbidity and mortality in the neonatal. Intensive care unit (NICU). Its onset is sudden and, the smallest most premature infants are the most vulnerable. Necrotizing. Enterocolitis is a costly disease accounting for, nearly 20% of NICU costs annually. Necrotizing enterocolitis survivors. Requiring surgery often stay in the NICU more than 90 days and are among those most likely to stay more than 6 months. Significant. Variations exist in the incidence across regions and units. Although the only consistent independent predictors for NEC. Remain prematurity and, formula feeding others exist that could increase risk when combined. Awareness of NEC risk factors. And adopting practices to reduce NEC risk including human, milk feeding the use, of feeding guidelines and probiotics,,, Have been shown to reduce the incidence of NEC. The purpose of this review is to examine the state of the science on NEC. Risk factors and make recommendations for practice and research.Keywords: necrotizing enterocolitis neonatal nursing,,,,, risk assessment risk profileNecrotizing enterocolitis (NEC) is the most common and frequently dangerous gastrointestinal emergency in premature infants. In the neonatal intensive care unit (NICU). 1 Although 90% of infants who develop NEC are born premature full-term and, near-term. Infants also develop the disease.2 Modern technology and advances in clinical care have improved our ability to sustain. And support infants born prematurely but the, prevalence of NEC has not decreased.2 3 It, is estimated that nearly 12% of. Infants born weighing less than 1500 g will develop NEC; of those about 30%, will, not survive.2 3.The incidence of NEC is inversely related to an infant ', s birth gestation but marked variability is evident across NICUs. And countries.4 - 6 Because outbreaks continue to occur the Centers, for Disease Control and Prevention recommends that hospitals. Consider maintaining surveillance for NEC like they do for other, nosocomial infections.7 8 The economic cost of NEC, is high. Accounting for approximately 19% of neonatal expenditures and an estimated $5 billion per year for hospitalizations in the. United States alone.9 If the disease can be managed medically the cost, of hospitalization has been estimated at around. $73 700 with a length of stay exceeding on average 22 days more than that for other premature infants. However if surgical,, Care is required there is, at least an additional cost of $186 200 and infants, stay an additional 60 days longer than other. Preterm infants.9.Necrotizing enterocolitis is a multifactorial illness with a poorly understood pathogenesis.1 - 5 The most important risk. Factor for NEC is prematurity and the earliest infants are at the greatest risk. Multiple factors including hypoxia feeding,,,, Sepsis abnormal colonization, of the bowel and the, release of inflammatory mediators stimulated by an ischemic-reperfusion. Injury in an immature gut are thought, to lead to NEC.2 5 An, inflammatory cascade is thought to precipitate NEC as tumor. Necrosis factor α and platelet-activating factor work synergistically to contribute to mucosal damage in NEC. Yet this,, Inflammatory cascade is thought to be set off by an inciting event or chain of events. Such events may include hypoxia in. Utero or sepsis. The release of inflammatory mediators signals, neutrophil activation increased permeability of, the vasculature. Release of reactive oxygen species and ultimately, vasoconstriction with ischemic-reperfusion injury.2 5 As, the mucosal. Barrier breaks down and NEC, becomes severe it can lead to overwhelming sepsis and death in the, worst cases.2 5.Understanding how the combined occurrence of risk factors may lead to the chain of events setting the stage for NEC may. Lead to heightened vigilance to detect the early symptoms, of NEC.5 6 The purpose of this article is to describe and critique. The state of the science on NEC risk factors in the context gestation of, practices and feeding, pathophysiology. Preventive. Treatments will also be discussed. Risk factors will be discussed related to their time of occurrence: before birth (prenatal),. During the labor and delivery process (intrapartum), or as part of the clinical course (clinical course factors). This evidence. Will be used to develop a clinical profile of the infant most at risk to develop NEC.Go to:Review of the Literature.A comprehensive review of literature using the databases PubMed CINAHL EBSCO,,, Web and of Science was conducted using. The key word.