Hematological problems in the neonate
Prem Puri in Newborn Surgery, 2017
Necrotizing enterocolitis (NEC) is a common and serious gastrointestinal disorder that predominantly affects premature infants. Ninety percent of neonates with NEC develop late onset thrombocytopenia. It is often severe and associated with bleeding.21
Mucosal manifestations of immunodeficiencies
Phillip D. Smith, Richard S. Blumberg, Thomas T. MacDonald in Principles of Mucosal Immunology, 2020
Lymphopenia (particularly among CD8 T lymphocytes), impaired in vitro proliferation to immobilized anti-CD3, reduced serum IgM with increased levels of IgA and IgE, and inability to mount effective antibody responses, especially to T-independent antigens, are typical immunologic findings. The basis for the autoimmunity in WAS is still unclear but may represent aberrant effector T-cell, regulatory T-cell, NK cell, dendritic cell, macrophage, or other innate immune function. Treatment of WAS is based on regular administration of intravenous immunoglobulins, antibiotic prophylaxis, topical steroids to control eczema, and use of vigorous immune suppression when autoimmune manifestations are present. Splenectomy may increase the platelet count in the majority of patients but carries significant risks of invasive infection by encapsulated pathogens. The only curative approach to WAS is represented by HCT, which gives optimal results when performed from HLA-identical family donors or early in life from matched unrelated donors. Gene therapy trials have been initiated with promising results. WAS patients can present with life-threatening gastrointestinal bleeding associated with severe thrombocytopenia (over 25% of patients presenting with hematemesis or melena in one series). Chronic diarrhea is also a common feature of classical WAS, most often associated with infectious etiologies. Moreover, a significant fraction of patients (nearly 10% in one series) can present with an inflammatory disorder of the intestine resembling inflammatory bowel disease. These patients can present with inflammatory lesions anywhere in the gastrointestinal tract with disease resembling both Crohn's disease and ulcerative colitis. Rarely, patients can present with a clinical picture consistent with necrotizing enterocolitis. Similar to WAS patients, mice deficient in WASp can also develop severe colitis associated with helper-T (T) T2 cytokine skewing and defects in regulatory T cells.
Gastroschisis
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
Intestinal atresia can be delayed by the creation of a stoma if primary abdominal wall closure is possible or by delaying the atresia repair if staged reduction is undertaken. A stoma can be created at the time of removal of the Silastic silo and primary abdominal wall closure. Another and devastating in utero complication can be loss of midgut blood supply by volvulus or kinking at the level of the abdominal wall defect, resulting in midgut infarction and being born with a short segment of jejunum and residual transverse and left colon. These unfortunate infants will have extreme short bowel syndrome. Another source of intestinal infarction can occur postnatally because of excessive intra-abdominal pressure or kinking of the blood supply to the bowel at the time of reduction of the herniated bowel. This complication may lead to the death of the patient or to short bowel syndrome. Additional complications associated with the abdominal wall closure are wound dehiscence and intestinal–cutaneous fistula formation. These complications are also often associated with excessive intra-abdominal pressure and excessive tension on the abdominal wall closure. It is preferable to use the staged reduction approach when primary abdominal wall closure might result in excessive intra-abdominal pressure. Wound infection is relatively common, especially following delayed abdominal wall closure due to colonization of the wound from the presence of the foreign body (silo). A delayed complication is the development of necrotizing enterocolitis. The incidence of necrotizing enterocolitis in patients with gastroschisis has been reported to be as high as 20%. It generally has a delayed onset, usually 3–6 weeks after birth. The cause remains unknown, but associations have been made with total parenteral nutrition (TPN)-induced cholestasis, excessive or accelerated postoperative feeding. Necrotizing enterocolitis associated with gastroschisis can be mild or severe and can involve a significant portion of the bowel, resulting in a high mortality. Finally, sepsis, resulting from intra-abdominal or wound infections, and central line infections are additional causes of morbidity in patients with gastroschisis.
Biomarkers of necrotizing enterocolitis: a review of literature
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2018
Bhawan Deep Garg, Deepak Sharma, Anju Bansal
Necrotizing enterocolitis (NEC) is among the most serious gastrointestinal emergency in very low birth weight (VLBW), extremely low birth weight (ELBW) and extremely low gestational age neonates (ELGAN), affecting 7–14% of these neonates. Despite extensive research, the underlying aetiology of NEC still remains blurred. Due to high mortality, morbidity and its delayed presentation, early detection of NEC is considered to be lifesaving. A number of biomarkers have been studied for early detection and prediction of severity of NEC but till date, no ideal marker has been discovered. Molecular techniques like proteomic and metabolomic have recently emerged in the field for the development of biomarkers for early detection and understanding the pathophysiology of NEC. We did literature search for identifying all biomarkers that have been used for the detection of NEC and, in this review article, we discuss these biomarkers along with the available current evidence.
Physiological effects of prebiotics and its role in prevention of necrotizing enterocolitis in preterm neonates
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2018
Bhawan Deep Garg, Haribalakrishna Balasubramanian, Nandkishor S. Kabra
Necrotizing enterocolitis (NEC) is one of the most serious gastrointestinal emergencies in very low birth weight (VLBW) preterm neonates, affecting 7–14% of these neonates. Due to the seriousness of the disease, prevention of NEC is the most important goal. Current evidence from systematic review and meta-analysis revealed that probiotics are the most promising intervention in reduction of the incidence of NEC in VLBW neonates. As per the evidence, prebiotics modulate the composition of human intestine microflora to the benefit of the host by suppression of colonization of harmful microorganism and/or the stimulation of bifidobacterial growth, decreased stool viscosity, reduced gastrointestinal transit time, and better feed tolerance. Prebiotics may be potential alternatives or adjunctive therapies to probiotics, despite a lack of evidence supporting its clinical efficacy in prevention of NEC. In this article, we discuss evidence-based physiological effects of prebiotics and its therapeutic role in prevention of NEC.
Lactoferrin and neonatology – role in neonatal sepsis and necrotizing enterocolitis: present, past and future
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2016
Neonatal sepsis and necrotizing enterocolitis (NEC) are two most important neonatal problems in nursery which constitute the bulk of neonatal mortality and morbidity. Inflammatory mediators secondary to sepsis and NEC increases morbidity, by affecting various system of body like lung, brain and eye, thus causing long term implications. Lactoferrin (LF) is a component of breast milk and multiple actions that includes antimicrobial, antiviral, anti-fungal and anti-cancer and various other actions. Few studies have been completed and a number of them are in progress for evaluation of efficacy and safety of LF in the prevention of neonatal sepsis and NEC in field of neonatology. In future, LF prophylaxis and therapy may have a significant impact in improving clinical outcomes of vulnerable preterm neonates. This review analyse the role of lactoferrin in prevention of neonatal sepsis and NEC, with emphasis on mechanism of action, recent studies and current studies going on around the globe.
Related Knowledge Centers
- Enterocolitis
- Mucosa
- Necrosis
- Ulcer
- Small Intestine
- Large Intestine
- Low Birth Weight Infant