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      Necrotizing enterocolitis: treatment based on staging criteria.

      Pediatric Clinics of North America

      Anti-Bacterial Agents, therapy, epidemiology, diagnosis, Infant, Premature, Diseases, Infant, Newborn, Humans, Fluid Therapy, Fetal Organ Maturity, Enterocolitis, Pseudomembranous, adverse effects, Enteral Nutrition, embryology, Digestive System, Bacterial Infections, therapeutic use

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          Abstract

          Neonatal necrotizing enterocolitis is the most important cause of acquired gastrointestinal morbidity or mortality among low birthweight infants. Prematurity alone is probably the only identifiable risk factor. Although the etiology is unknown NEC has many similarities to an infectious disease. Proper staging helps improve reporting and the management of NEC.

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          Most cited references 60

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          Epidemiology of necrotizing enterocolitis: a case control study.

          All neonates with necrotizing enterocoltis cared for at Grady Memorial Hospital from July, 1977, through February, 1979, were compared with controls matched for birth weight and time of admission to the nursery, to examine risk factors which have been implicated in the etiology of the disease. Data on maternal history, birth history, and hospital course were uniformly collected and contrasted for 35 cases and 98 controls. Low birth weight was associated with an increased incidence of NEC and an increased case fatality rate. All babies 36 weeks or more at birth were diagnosed by seven days. More immature infants developed the disease later in their hospital course. In addition, preterm babies who developed NEC after 2 weeks of age appear to be smaller and sicker. Factors previously thought to predispose an infant to the development of the disease, such as prolonged rupture of membranes, infectious complications of pregnancy, low Apgar scores, patent ductus arteriosus, and use of umbilical catheters, were found with equal frequency in cases and controls and may simply represent the descriptive characteristics of a population of sick premature infants. Feeding history and antibiotic use were examined in depth and were not correlated with the development of NEC.
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            An outbreak of rotavirus-associated neonatal necrotizing enterocolitis *

            An outbreak of necrotizing enterocolitis and hemorrhagic gastroenteritis occurred in two nurseries during 25 days in August 1982. Eleven of the 40 patients in these nurseries during that time developed disease (attack rate 27.5%). In seven of the 10 patients with gastrointestinal disease, stool samples tested for human rotavirus were positive by ELISA, whereas in 20 unaffected infants, no stools tested demonstrated HRV (P=0.0001). Eleven staff members had serologic evidence of recent HRV infection. Comparison of risk factors traditionally associated with the development of NEC between the affected and unaffected infants revealed no significant differences. Rotavirus infection was the only finding that was highly correlated with this epidemic.
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              Clostridium difficile toxin in asymptomatic neonates.

              Clostridium difficile toxin was detected in the feces of 10.5% of normal newborn infants and 55% of neonates in the intensive care unit. None of the normal infants and less than one-third of those in the NICU had any signs of enteric illness. Vaginal delivery and breast-feeding were associated with increased rates of toxin carriage. Although toxin was not detected during antibiotic therapy, it could be found in 85% of infants two weeks or more, and for at least an additional two months, following exposure to antibiotics.
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                Journal
                3081865

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