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BMJ Open. 2019 Oct 14;9(10):e031086. doi: 10.1136/bmjopen-2019-031086.

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

Collaborators (275)

Haslam R, Marshall P, Schmidt P, Buckmaster A, Craven P, Waal K, Simmer K, Gill A, Pillow J, Stack J, Cooke L, Casalaz D, Holberton J, Barfield C, Downe L, Shingde V, Stewart M, Bajuk B, Berry A, Hunt R, Kilburn C, Paoli T, Lui K, Paradisis M, Rieger I, Reid S, Cartwright D, Koorts P, Kuschel C, Doyle L, Numa A, Carlisle H, Badawi N, Halliday R, Koh G, Resnick S, Luig M, Andersen C, Chambers G, Lynn A, Darlow B, Broadbent R, Mildenhall L, Buksh M, Battin M, Boom JVD, Bourchier D, Carpenter L, Richardson V, Rajadurai VS, Shah PS, Harrison A, Synnes A, Cieslak Z, Sherlock R, Yee W, Aziz K, Fajardo C, Kalapesi Z, Sankaran K, Seshia M, Alvaro R, Mukerji A, Silva OD, Nwaesei C, Lee KS, Dunn M, Lemyre B, Dow K, Pelausa E, Barrington K, Drolet C, Piedboeuf B, Claveau M, Beltempo M, Bertelle V, Masse E, Canning R, Makary H, Ojah C, Monterrosa L, Deshpandey A, Afifi J, Kajetanowicz A, Lee SK, Andersson S, Lehtonen L, Tammela O, Sankilampi U, Saarela T, Heymann E, Zangen S, Smolkin T, Mimouni F, Bader D, Rothschild A, Strauss Z, Felszer C, Omari H, Tov-Friedman SE, Bar-Oz B, Feldman M, Saad N, Flidel-Rimon O, Weisbrod M, Lubin D, Litmanovitz I, Kugelman A, Shinwell E, Klinger G, Nijim Y, Bin-Nun A, Golan A, Mandel D, Fleisher-Sheffer V, Kohelet D, Bakhrakh L, Avila-Alvarez A, Fernandez-Trisac JL, Pico MLC, Fernández Seara MJ, Gutiérrez AM, Vizcaíno C, Iglesias MS, Zaplana HS, Colomer BF, García López JE, Rafael García Mozo M, Martínez TG, Muro Sebastián MD, Carbonell MB, Barnusell JB, Puiggròs MD, Taulí CP, Aloy JF, Mussons FB, Sanz IA, Galiana GG, Coroleu W, Iriondo M, Vilella LC, Porta R, Demestre X, Nadal SM, Martínez CF, López Cuesta MJ, Mora DE, Tardío JO, Benavente I, Alonso A, Olmos RA, García Cabezas MA, Martínez Jiménez MD, Jaraba Caballero MP, Ordoñez Díaz MD, Fagundo AT, Canals LM, Rodrigo FG, Martí LU, Moreno Galdo MF, Hurtado Suazo JA, López EN, Fernández JU, Cortajarena Altuna MA, Muga O, Navarro DM, Domínguez MT, Ruiz Del Prado MY, Esteban Díez I, Palau Benavides MT, Lapeña S, Prada T, Mir ES, Sánchez AC, Vega EC, Prado ND, Fernández C, Vilaplana LC, Pérez IC, Gómez LL, Comeche LD, Martín IL, Armengod CG, Labián CM, Santos Muñoz MJ, Bravo DB, Pérez V, Elorza Fernández MD, González CD, Segura SA, Azorín ML, Jimenez AB, Sánchez-Tamayo T, Moreno ET, González M, Del Arco BV, Fernández JM, Gordillo LA, Asensio MG, Díaz CM, Albújar M, Jorge PF, Romero S, Escobar Izquierdo AB, Estañ Capell J, Izquierdo Macián MI, Montejo Vicente MM, Caballero RI, Martínez MM, Euba A, Serna AR, López de Heredia Goya JM, Legorburu AP, Amorós AG, Marugán Isabel VM, González NH, Gracia SR, Ventura Faci MP, Samper Villagrasa MP, Kofron J, Brodd KS, Odlind A, Alberg L, Arwehed S, Hafström O, Kasemo A, Nederman K, Åhman L, Ingemarsson F, Petersson H, Thurn P, Albinsson E, Selander B, Abrahamsson T, Heimdahl I, Sveinsdottir K, Wejryd E, Hedlund A, Söderberg MK, Hallberg B, Brune T, Bäckström J, Robinson J, Farooqi A, Normann E, Fredriksson M, Palm A, Rosenqvist U, Walde B, Hagman C, Ohlin A, Florell R, Smedsaas-Löfvenberg A, Meyer P, Anderegg C, Schulzke S, Nelle M, Wagner B, Riedel T, Kaczala G, Pfister RE, Tolsa JF, Roth M, Stocker M, Laubscher B, Malzacher A, Micallef JP, Hegi L, Bassler D, Arlettaz R, Dani C, Fiorini P, Ghirri P, Tomasini B, Rusconi F.

Author information

1
Department of Neonatology, University Hospital Zurich, Zurich, Switzerland mark.adams@usz.ch.
2
Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
3
Department of Neonatology, University Hospital Zurich, Zurich, Switzerland.
4
Department of Paediatrics, University of Otago, Christchurch, Otago, New Zealand.
5
Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.
6
Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel.
7
Department of Clinical Sciences/Pediatrics, Umeå University Hospital, Umeå, Sweden.
8
Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
9
Department of Paediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.
10
Department of Pediatrics, Turku University Hospital, Turku, Finland.
11
Department of Pediatrics, University of Turku, Turku, Finland.
12
Division of Neonatology, University Hospital Salamanca, Salamanca, Spain.
13
Division of Neonatology and Health Research Institute La Fe, University of Valencia, Valencia, Spain.
14
Neonatal Intensive Care Unit, Anna Meyer Children's University Hospital, Florence, Italy.
15
Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada.

Abstract

OBJECTIVES:

To 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.

DESIGN:

Prospective unit-level survey combined with retrospective cohort study.

SETTING:

Neonatal intensive care units in Australia/New Zealand, Canada, Finland, Israel, Spain, Sweden, Switzerland and Tuscany (Italy).

PATIENTS:

Extremely preterm infants born between 240 to 286 weeks' gestation, with birth weights<1500 g, and admitted between 2014-2015.

EXPOSURES:

NEC 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 MEASURES:

Surgical NEC rates and death following NEC using cohort data.

RESULTS:

The 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.

CONCLUSIONS:

The 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.

KEYWORDS:

neonatology; paediatric gastroenterology; paediatrics; perinatology

Conflict of interest statement

Competing interests: MA receives a salary as network coordinator for the Swiss Neonatal Network.

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