The role of nutrition in analysis of risk factors and short-term outcomes for late-onset necrotizing enterocolitis among very preterm infants: a nationwide, multicenter study in China
© 2024. The Author(s)..
BACKGROUND: Necrotizing enterocolitis (NEC) is a serious gastrointestinal disease, primarily affects preterm newborns and occurs after 7 days of life (late-onset NEC, LO-NEC). Unfortunately, over the past several decades, not much progress has been made in its treatment or prevention. This study aimed to analyze the risk factors for LO-NEC, and the impact of LO-NEC on short-term outcomes in very preterm infants (VPIs) with a focus on nutrition and different onset times.
METHOD: Clinical data of VPIs were retrospectively collected from 28 hospitals in seven different regions of China from September 2019 to December 2020. A total of 2509 enrolled VPIs were divided into 2 groups: the LO-NEC group and non-LO-NEC group. The LO-NEC group was divided into 2 subgroups based on the onset time: LO-NEC occurring between 8 ~ 14d group and LO-NEC occurring after 14d group. Clinical characteristics, nutritional status, and the short-term clinical outcomes were analyzed and compared among these groups.
RESULTS: Compared with the non-LO-NEC group, the LO-NEC group had a higher proportion of anemia, blood transfusion, and invasive mechanical ventilation (IMV) treatments before NEC; the LO-NEC group infants had a longer fasting time, required longer duration to achieve the target total caloric intake (110 kcal/kg) and regain birthweight, and showed slower weight growth velocity; the cumulative dose of the medium-chain and long-chain triglyceride (MCT/LCT) emulsion intake in the first week after birth was higher and breastfeeding rate was lower. Additionally, similar results including a higher proportion of IMV, lower breastfeeding rate, more MCT/LCT emulsion intake, slower growth velocity were also found in the LO-NEC group occurring between 8 ~ 14d when compared to the LO-NEC group occurring after 14 d (all (P < 0.05). After adjustment for the confounding factors, high proportion of breastfeeding were identified as protective factors and long fasting time before NEC were identified as risk factors for LO-NEC; early feeding were identified as protective factors and low gestational age, grade III ~ IV neonatal respiratory distress syndrome (NRDS), high accumulation of the MCT/LCT emulsion in the first week were identified as risk factors for LO-NEC occurring between 8 ~ 14d. Logistic regression analysis showed that LO-NEC was a risk factor for late-onset sepsis, parenteral nutrition-associated cholestasis, metabolic bone disease of prematurity, and extrauterine growth retardation.
CONCLUSION: Actively preventing premature birth, standardizing the treatment of grade III ~ IV NRDS, and optimizing enteral and parenteral nutrition strategies may help reduce the risk of LO-NEC, especially those occurring between 8 ~ 14d, which may further ameliorate the short-term clinical outcome of VPIs.
TRIAL REGISTRATION: ChiCTR1900023418 (26/05/2019).
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
BMC pediatrics - 24(2024), 1 vom: 08. März, Seite 172 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hong, Kun-Yao [VerfasserIn] |
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| Links: |
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| Themen: |
Emulsions |
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| Anmerkungen: |
Date Completed 11.03.2024 Date Revised 12.03.2024 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1186/s12887-024-04611-7 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369491750 |
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| 100 | 1 | |a Hong, Kun-Yao |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The role of nutrition in analysis of risk factors and short-term outcomes for late-onset necrotizing enterocolitis among very preterm infants: a nationwide, multicenter study in China |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Completed 11.03.2024 | ||
| 500 | |a Date Revised 12.03.2024 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2024. The Author(s). | ||
| 520 | |a BACKGROUND: Necrotizing enterocolitis (NEC) is a serious gastrointestinal disease, primarily affects preterm newborns and occurs after 7 days of life (late-onset NEC, LO-NEC). Unfortunately, over the past several decades, not much progress has been made in its treatment or prevention. This study aimed to analyze the risk factors for LO-NEC, and the impact of LO-NEC on short-term outcomes in very preterm infants (VPIs) with a focus on nutrition and different onset times | ||
| 520 | |a METHOD: Clinical data of VPIs were retrospectively collected from 28 hospitals in seven different regions of China from September 2019 to December 2020. A total of 2509 enrolled VPIs were divided into 2 groups: the LO-NEC group and non-LO-NEC group. The LO-NEC group was divided into 2 subgroups based on the onset time: LO-NEC occurring between 8 ~ 14d group and LO-NEC occurring after 14d group. Clinical characteristics, nutritional status, and the short-term clinical outcomes were analyzed and compared among these groups | ||
| 520 | |a RESULTS: Compared with the non-LO-NEC group, the LO-NEC group had a higher proportion of anemia, blood transfusion, and invasive mechanical ventilation (IMV) treatments before NEC; the LO-NEC group infants had a longer fasting time, required longer duration to achieve the target total caloric intake (110 kcal/kg) and regain birthweight, and showed slower weight growth velocity; the cumulative dose of the medium-chain and long-chain triglyceride (MCT/LCT) emulsion intake in the first week after birth was higher and breastfeeding rate was lower. Additionally, similar results including a higher proportion of IMV, lower breastfeeding rate, more MCT/LCT emulsion intake, slower growth velocity were also found in the LO-NEC group occurring between 8 ~ 14d when compared to the LO-NEC group occurring after 14 d (all (P < 0.05). After adjustment for the confounding factors, high proportion of breastfeeding were identified as protective factors and long fasting time before NEC were identified as risk factors for LO-NEC; early feeding were identified as protective factors and low gestational age, grade III ~ IV neonatal respiratory distress syndrome (NRDS), high accumulation of the MCT/LCT emulsion in the first week were identified as risk factors for LO-NEC occurring between 8 ~ 14d. Logistic regression analysis showed that LO-NEC was a risk factor for late-onset sepsis, parenteral nutrition-associated cholestasis, metabolic bone disease of prematurity, and extrauterine growth retardation | ||
| 520 | |a CONCLUSION: Actively preventing premature birth, standardizing the treatment of grade III ~ IV NRDS, and optimizing enteral and parenteral nutrition strategies may help reduce the risk of LO-NEC, especially those occurring between 8 ~ 14d, which may further ameliorate the short-term clinical outcome of VPIs | ||
| 520 | |a TRIAL REGISTRATION: ChiCTR1900023418 (26/05/2019) | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Extrauterine growth restriction | |
| 650 | 4 | |a Late-onset NEC | |
| 650 | 4 | |a Late-onset sepsis | |
| 650 | 4 | |a Risk factors, Breastfeeding | |
| 650 | 4 | |a Very preterm infants | |
| 650 | 7 | |a Emulsions |2 NLM | |
| 700 | 1 | |a Zhu, Yao |e verfasserin |4 aut | |
| 700 | 1 | |a Wu, Fan |e verfasserin |4 aut | |
| 700 | 1 | |a Mao, Jian |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Ling |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Rong |e verfasserin |4 aut | |
| 700 | 1 | |a Chang, Yan-Mei |e verfasserin |4 aut | |
| 700 | 1 | |a Shen, Wei |e verfasserin |4 aut | |
| 700 | 1 | |a Tang, Li-Xia |e verfasserin |4 aut | |
| 700 | 1 | |a Ye, Xiu-Zhen |e verfasserin |4 aut | |
| 700 | 1 | |a Qiu, Yin-Ping |e verfasserin |4 aut | |
| 700 | 1 | |a Ma, Li |e verfasserin |4 aut | |
| 700 | 1 | |a Cheng, Rui |e verfasserin |4 aut | |
| 700 | 1 | |a Wu, Hui |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Dong-Mei |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Ling |e verfasserin |4 aut | |
| 700 | 1 | |a Xu, Ping |e verfasserin |4 aut | |
| 700 | 1 | |a Mei, Hua |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, San-Nan |e verfasserin |4 aut | |
| 700 | 1 | |a Xu, Fa-Lin |e verfasserin |4 aut | |
| 700 | 1 | |a Ju, Rong |e verfasserin |4 aut | |
| 700 | 1 | |a Zheng, Zhi |e verfasserin |4 aut | |
| 700 | 1 | |a Tong, Xiao-Mei |e verfasserin |4 aut | |
| 700 | 1 | |a Lin, Xin-Zhu |e verfasserin |4 aut | |
| 700 | 0 | |a Chinese Multicenter EUGR Collaborative Group |e verfasserin |4 aut | |
| 700 | 1 | |a Hong, Kun Yao |e investigator |4 oth | |
| 700 | 1 | |a Zhu, Yao |e investigator |4 oth | |
| 700 | 1 | |a Shen, Wei |e investigator |4 oth | |
| 700 | 1 | |a Tang, Li-Xia |e investigator |4 oth | |
| 700 | 1 | |a Zheng, Zhi |e investigator |4 oth | |
| 700 | 1 | |a Lin, Xin-Zhu |e investigator |4 oth | |
| 700 | 1 | |a Wu, Fan |e investigator |4 oth | |
| 700 | 1 | |a Tian, Qian-Xin |e investigator |4 oth | |
| 700 | 1 | |a Cui, Qi-Liang |e investigator |4 oth | |
| 700 | 1 | |a Mao, Jian |e investigator |4 oth | |
| 700 | 1 | |a Yuan, Yuan |e investigator |4 oth | |
| 700 | 1 | |a Ren, Ling |e investigator |4 oth | |
| 700 | 1 | |a Liu, Ling |e investigator |4 oth | |
| 700 | 1 | |a Shi, Bi-Zhen |e investigator |4 oth | |
| 700 | 1 | |a Wang, Yu-Mei |e investigator |4 oth | |
| 700 | 1 | |a Chang, Yan-Mei |e investigator |4 oth | |
| 700 | 1 | |a Zhang, Jing-Hui |e investigator |4 oth | |
| 700 | 1 | |a Tong, Xiao-Mei |e investigator |4 oth | |
| 700 | 1 | |a Zhang, Rong |e investigator |4 oth | |
| 700 | 1 | |a Zhu, Yan |e investigator |4 oth | |
| 700 | 1 | |a Ye, Xiu-Zhen |e investigator |4 oth | |
| 700 | 1 | |a Zou, Jing-Jing |e investigator |4 oth | |
| 700 | 1 | |a Qiu, Yin-Ping |e investigator |4 oth | |
| 700 | 1 | |a Li, Yu-Huai |e investigator |4 oth | |
| 700 | 1 | |a Zhao, Bao-Yin |e investigator |4 oth | |
| 700 | 1 | |a Liu, Shu-Hua |e investigator |4 oth | |
| 700 | 1 | |a Ma, Li |e investigator |4 oth | |
| 700 | 1 | |a Xu, Ying |e investigator |4 oth | |
| 700 | 1 | |a Cheng, Rui |e investigator |4 oth | |
| 700 | 1 | |a Zhou, Wen-Li |e investigator |4 oth | |
| 700 | 1 | |a Wu, Hui |e investigator |4 oth | |
| 700 | 1 | |a Liu, Zhi-Yong |e investigator |4 oth | |
| 700 | 1 | |a Chen, Dong-Mei |e investigator |4 oth | |
| 700 | 1 | |a Gao, Jin-Zhi |e investigator |4 oth | |
| 700 | 1 | |a Liu, Jing |e investigator |4 oth | |
| 700 | 1 | |a Chen, Ling |e investigator |4 oth | |
| 700 | 1 | |a Li, Cong |e investigator |4 oth | |
| 700 | 1 | |a Yang, Chun-Yan |e investigator |4 oth | |
| 700 | 1 | |a Xu, Ping |e investigator |4 oth | |
| 700 | 1 | |a Zhang, Ya-Yu |e investigator |4 oth | |
| 700 | 1 | |a Hu, Si-Le |e investigator |4 oth | |
| 700 | 1 | |a Mei, Hua |e investigator |4 oth | |
| 700 | 1 | |a Yang, Zu-Ming |e investigator |4 oth | |
| 700 | 1 | |a Feng, Zong-Tai |e investigator |4 oth | |
| 700 | 1 | |a Wang, San-Nan |e investigator |4 oth | |
| 700 | 1 | |a Meng, Er-Yan |e investigator |4 oth | |
| 700 | 1 | |a Shang, Li-Hong |e investigator |4 oth | |
| 700 | 1 | |a Xu, Fa-Lin |e investigator |4 oth | |
| 700 | 1 | |a Ou, Shaoping |e investigator |4 oth | |
| 700 | 1 | |a Ju, Rong |e investigator |4 oth | |
| 700 | 1 | |a Li, Gui-Nan |e investigator |4 oth | |
| 700 | 1 | |a Yi, Juan |e investigator |4 oth | |
| 700 | 1 | |a Li, Long |e investigator |4 oth | |
| 700 | 1 | |a Liu, Yong-Qiao |e investigator |4 oth | |
| 700 | 1 | |a Zhang, Zhe |e investigator |4 oth | |
| 700 | 1 | |a Wu, Mei-Gui |e investigator |4 oth | |
| 700 | 1 | |a Bei, Fei |e investigator |4 oth | |
| 700 | 1 | |a Liu, Ye |e investigator |4 oth | |
| 700 | 1 | |a Deng, Chun |e investigator |4 oth | |
| 700 | 1 | |a Yang, Hui-Jie |e investigator |4 oth | |
| 700 | 1 | |a Su, Ping |e investigator |4 oth | |
| 700 | 1 | |a Chen, Shi-Feng |e investigator |4 oth | |
| 700 | 1 | |a Luo, Ling-Ying |e investigator |4 oth | |
| 700 | 1 | |a Wang, Lin-Lin |e investigator |4 oth | |
| 700 | 1 | |a Liu, Xiao-Hong |e investigator |4 oth | |
| 700 | 1 | |a Yan, Li-Hua |e investigator |4 oth | |
| 700 | 1 | |a Wang, Li-Jun |e investigator |4 oth | |
| 700 | 1 | |a Wang, Xiao-Kang |e investigator |4 oth | |
| 700 | 1 | |a Yu, Shu-Qun |e investigator |4 oth | |
| 700 | 1 | |a Zhu, Qiao-Mian |e investigator |4 oth | |
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