Mechanism of necrotizing enterocolitis in preterm infants through the hypoxia signaling pathway, neuronal-glial signaling pathway, and intestinal fatty acid signaling pathway

The etiology of necrotizing enterocolitis (NEC) is influenced by many factors including hypoxia, intestinal immaturity, bacterial colonization, reactive oxidants, and imbalanced inflammatory response; therefore, the pathogenesis of NEC is considered multifactorial. However, the pathogenesis of NEC has not been fully elucidated and requires further investigation. This study aimed to analyze the association between hypoxia inducible factor-1alpha (HIF-1alpha), glial fibrillary acidic protein (GFAP), glial derived neutrophic factor (GDNF), fatty acid binding protein-2 (FABP-2), peroxime proliferator activated receptor-gamma (PPAR-gamma), interleukin-6 (IL-6), and interleukin-8 (IL-8) with the incidence of NEC in preterm infants. All preterm infants with birth weight <1500 grams or gestational age <34 weeks were included in this study. After the umbilical cord was removed, 1 mL of umbilical blood was taken for HIF-1alpha, GFAP, GDNF, FABP-2, PPAR-gamma, IL-6, and IL-8 examination. Examination of HIF-1alpha, GFAP, GDNF, FABP-2, PPAR-gamma, IL-6, and IL-8 was repeated in infants with NEC symptoms using peripheral venous blood specimen. Infants were observed for 2 weeks. NEC was diagnosed based on clinical symptoms and abnormal abdominal radiographs. Of the 30 infants, there were 9 (30%) infants who experienced NEC. Logistic regression analysis showed significant results on GFAP with Odds Ratio (OR)=15.629 (95% confidence interval=1.697-143.906) P=0.015 and FABP-2 with OR=1.008 (1.001-1.015) P=0.033. Multivariate analysis using Backward LR logistic regression model showed significant results on GFAP with adjusted OR=15.629 (1.697-143.906) with P=0.015. This study demonstrated that GFAP and FABP-2 were significantly associated with the incidence of NEC. This may explain the pathogenesis of NEC through a hypoxic mechanism

The incidence of osteopenia of prematurity in preterm infants without phosphate supplementation A prospective, observational study:A prospective, observational study

ABSTRACT: To meet their requirements for bone mineralization, it is recommended that preterm infants receive nutritional support containing calcium and phosphate. There are no clear data on the incidence of osteopenia of prematurity (OFP) in preterm infants without phosphate supplementation.This study aimed to investigate the incidence of OFP in preterm infants without phosphate supplementation and its relationship with the duration of parenteral nutrition (PN).This was a prospective and observational study.This study included 30 infants aged 15 days significantly increased the risk of OFP (odds ratio, 5.40; 95% confidence interval, 1.12-26.04; P = .035).We found a high incidence of OFP in preterm infants without phosphate supplementation. An association was found between the duration of PN and the incidence of OFP. Further research is needed to prevent the development of osteopenia in preterm infants

The Relationship Between Enteral and Parenteral Nutrition on Body Weight, Incidence of NEC, Sepsis and Length of Care for Preterm Infant in Dr. Soetomo General Hospital Surabaya

The incidence of preterm birth in Indonesia still accounts for the highest mortality rate. Failure to provide adequate nutrition will have an impact on growth failure, risk of infection and longer duration of care for preterm infant. This study aims to analyzing the relationship between enteral and parenteral nutrition on body weight, the incidence of NEC, the incidence of sepsis and the length of care at Dr. Soetomo Hospital Surabaya. A total 106 subjects were enrolled, 78 infants were LBW, 19 infants were VLBW. Gestational age between 32-<37 weeks as many as 96 subjects. 68 infants were female. A total of 49 patients (46.2%) received parenteral nutrition. There is a relationship between enteral nutrition and the incidence of sepsis (p= 0.03), parenteral nutrition and body weight (p= 0.005), parenteral nutrition and the incidence of sepsis (p= 0.001), and parenteral nutrition and the length of care for preterm infants (p= 0.001). There is a relationship between enteral nutrition with the incidence of sepsis and parenteral nutrition with body weight, incidence of sepsis and length of care in preterm infants

Necrotizing Enterocolitis in Preterm Infants Born to Mother with COVID-19

Background: The COVID-19 pandemic has had a wide impact on both pregnant women and their babies. Necrotizing enterocolitis (NEC) is a gastrointestinal emergency in neonates with high morbidity and mortality. Objective: This study aims to investigate the incidence of NEC in preterm infants born to mothers with confirmed COVID-19. Methods: This observational study was conducted in neonatal intensive care unit at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, from May 2020 to April 2021. All preterm infants born to mothers with positive COVID-19 based on swab examination were included as study participants. PCR swab examination was performed within 48 hours after birth. The diagnosis of COVID-19 was defined as positive if the swab test result could detect the SARS-CoV-2 virus. The diagnosis of NEC was established by clinical symptoms and confirmed by abdominal radiography. Results: Out of 45 preterm infants included in this study, 6 infants experienced NEC. Factors that were significantly associated with the incidence of NEC included asphyxia and intubated mother. Positive PCR results from the infants alone did not significantly increase the risk of NEC. The combination of asphyxia and intubated mother (Odds Ratio [OR]=10.000, 95% Confidence Interval [CI]=1.056-94.677, P=0.020) and the combination of positive PCR result, asphyxia, and intubated mother (OR=2.438, 95% CI=1.673-3.551, P=0.007) were found to be significantly associated with the incidence of NEC Conclusion: Significant factors associated with the incidence of NEC in preterm infants born to mothers with COVID-19 included asphyxia and intubated mothers prior to delivery. A positive PCR result alone did not significantly increase the risk of NEC

Infection in Neonates and Infants: Epidemiology Aspects

Neonatal infection is a one of the major cause of death and morbidity, especially in the first week of their life. So it is important to know about epidemiology aspects of neonatal infection and prevent neonatal sepsis by early diagnosis of Early Onset Sepsis (EOS) and managed this condition, as the first golden hours in neonatal infection. The challenges for clinicians are three fold: (1) identifiying neonates with a high likelihood of sepsis promptly and initiating antimicrobial therapy; (2) distinguishing "high risk" healthy-appearing infants of infants with clnical signs who do not require treatment; and (3) discontinuing antimicrobial therapy once sepsis is deemed unlikely. The optimal treatment of infants with suspected EOS is broad-spectrum antimicrobial agents (ampicillin and aminoglycoside). Once the pathogen is identified, antimicrobial therapy should be naarowed (unless synergism is needed). Antimicrobial therapy should be discontinued at 48 hours in clinical situations in which the probability of sepsis is low

Surfactant Therapy for Meconium Aspiration Syndrome in Dr. Soetomo General Hospital: A Case Series.

Abstract INTRODUCTION: Meconium staining of amniotic fluid (MSAF) is a natural phenomenon in pregnant mothers and their fetuses. MSAF may lead to developing Meconium Aspiration Syndrome (MAS). Surfactant replacement therapy has recently emerged as a therapy in MAS, but no guideline outlines how to administer it properly. CASE PRESENTATION: We present two term neonates with severe MAS cases focusing on the bolus surfactant replacement therapy. The first baby was given surfactant at 23 hours after birth and the second baby at 8 hours after birth. We used Survanta (beractant) in the dose of 100 mg/kg BW in both cases. Clinical improvement was observed 24 hours after surfactant bolus administration with different clinical characteristics, treatment approaches, and outcomes. CONCLUSION: In conclusion, therapeutic surfactant bolus in severe MAS may improve outcomes without significant adverse side effects

Introduction of a neonatal pain and agitation protocol at neonatal intensive care unit Dr Soetomo Hospital Surabaya

Background : Neonate especially preterm are the most likely to be exposed with pain stimuli in the NICU. Repeated number of painful exposure have the potential for deleterious consequences alter vital sign and later neurodevelopmental outcome. Dr Soetomo Hospital not implemented neonatal pain and agitation protocol yet. Objective: To analyze the implementation of a neonatal pain management based on Neonatal Infant Pain Scale (NIPS) score Methods : Location in NICU from January to May 2016. The protocol of neonatal pain and agitation management was implemented. Staff behavior in neonatal pain management before introduction vs after implementation were evaluated. Results : There were 72 patients before introduction had gestational age (GA) 34.8 (SD 2.6) weeks, birth weight 2023.8 (SD 437) gram and 30 nurse were include. Forty two patients, GA 35.8 (SD 2.58) week, birth weight 1988 (SD 571) gram, and 15 nurses after implementation of pain management were included. Vein puncture was the most procedure that frequently performed (62.09%) followed by ROP screening examination (21.56%), heel prick (13.07%). Compliance of staff in assessment of pain was seen from increasing number of pain assessment from 62.78% (SD 22.19) to 90.49% (SD 14.07). There was a significant increase of sucrose (00.00 vs 80.62%) and lidocain cream (00.00 vs 78.97%) used. Inter-observer agreement between nurse to evaluate pain using NIPS score, kappa 0.88, p = 0.00. Conclusion: Compliance of pain assessment and management were increased after pain protocol implementation

Associated neonatal and maternal factors of osteopenia of prematurity in low resource setting: A cross-sectional study.

Abstract Objective Determining neonatal and maternal factors that are associated with the incidence of OFP. Methods This study employed a cross-sectional design, in which the participants were identified for clinical variables (sex, gestational age, birth weight, etc.), neonatal morbidity (sepsis, necrotizing enterocolitis (NEC), etc.), and maternal risk factors (premature rupture of membranes, preeclampsia, etc.). The data were analyzed using Chi-square test, independent t-test, and logistic regression test with p < 0.05. Results The birth weight ranged from 800 to 1495 g (1219 ± 225 g), of which 5 newborns (17%) were 15 days (OR = 5.4; 95% CI 1.120–26.044; p = 0.036), ALP level >500 U/L (OR = 2.889; 95% CI 1.703–4.900; p = 0.014), and PROM (OR = 5.4; 95% CI 1.039–28.533; p = 0.045). Conclusion The lack of phosphate intake, prolonged parenteral nutrition, ALP level >500 U/L, onset of vitamin D supplementation, and premature rupture of membranes are associated with the incidence of OFP