BMJ Open (Oct 2019)
Preventive strategies and factors associated with surgically treated necrotising enterocolitis in extremely preterm infants: an international unit survey linked with retrospective cohort data analysis
- Dirk Bassler,
- Kei Lui,
- Michael Dunn,
- Victor Samuel Rajadurai,
- Mikael Norman,
- Alejandro Avila-Alvarez,
- Marc Beltempo,
- Mark Adams,
- Barbara Bajuk,
- Malcolm Battin,
- Jean-François Tolsa,
- Ruben Alvaro,
- Chuks Nwaesei,
- Martine Claveau,
- Shoo K Lee,
- Prakesh S Shah,
- Zenon Cieslak,
- Rebecca Sherlock,
- Wendy Yee,
- Carlos Fajardo,
- Zarin Kalapesi,
- Koravangattu Sankaran,
- Mary Seshia,
- Amit Mukerji,
- Orlando Da Silva,
- Kyong-Soon Lee,
- Brigitte Lemyre,
- Kimberly Dow,
- Ermelinda Pelausa,
- Keith Barrington,
- Christine Drolet,
- Bruno Piedboeuf,
- Valerie Bertelle,
- Edith Masse,
- Roderick Canning,
- Hala Makary,
- Cecil Ojah,
- Luis Monterrosa,
- Jehier Afifi,
- Andrzej Kajetanowicz,
- lex Doyle,
- Roland Broadbent,
- Ross Haslam,
- Peter Marshall,
- Peter Schmidt,
- Paul Craven,
- Koert De Waal,
- Karen Simmer,
- Andy Gill,
- Jacqueline Stack,
- Dan Casalaz,
- Jim Holberton,
- Lucy Cooke,
- Lyn Downe,
- Michael Stewart,
- Andrew Berry,
- Rod Hunt,
- Charles Kilburn,
- Tony De Paoli,
- Mary Paradisis,
- Ingrid Rieger,
- Pieter Koorts,
- Carl Kuschel,
- Andrew Numa,
- Hazel Carlisle,
- Nadia Badawi,
- Guan Koh,
- Melissa Luig,
- Chad Andersen,
- Adrienne Lynn,
- Brian Darlow,
- Lindsay Mildenhall,
- Mariam Buksh,
- David Bourchier,
- Vaughan Richardson,
- Georgina Chambers,
- Robert Halliday,
- Thomas Riedel,
- Anne Synnes,
- Amir Kugelman,
- W Coroleu,
- Liisa Lehtonen,
- Brian A Darlow,
- Brian Reichman,
- Stellan Hakansson,
- Kjell K Helenius,
- Laura San Feliciano,
- Maximo Vento,
- Marco Moroni,
- Junmin Yang,
- Adam Buckmaster,
- Charles Barfield,
- Vijay Shingde,
- Shelley Reid,
- David Cartwright,
- Steven Resnick,
- Jutta van den Boom,
- Lee Carpenter,
- Adele Harrison,
- Khalid Aziz,
- Akhil Deshpandey,
- Sture Andersson,
- Outi Tammela,
- Ulla Sankilampi,
- Timo Saarela,
- Eli Heymann,
- Shmuel Zangen,
- Tatyana Smolkin,
- Francis Mimouni,
- David Bader,
- Avi Rothschild,
- Zipora Strauss,
- Clari Felszer,
- Hussam Omari,
- Smadar Even Tov-Friedman,
- Benjamin Bar-Oz,
- Michael Feldman,
- Nizar Saad,
- Orna Flidel-Rimon,
- Meir Weisbrod,
- Daniel Lubin,
- Ita Litmanovitz,
- Eric Shinwell,
- Gil Klinger,
- Yousif Nijim,
- Alona Bin-Nun,
- Agneta Golan,
- Dror Mandel,
- Vered Fleisher-Sheffer,
- David Kohelet,
- Lev Bakhrakh,
- José Luis Fernandez-Trisac,
- Ma Luz Couce Pico,
- María José Fernández Seara,
- Andrés Martínez Gutiérrez,
- Carolina Vizcaíno,
- Miriam Salvador Iglesias,
- Honorio Sánchez Zaplana,
- Belén Fernández Colomer,
- José Enrique García López,
- M Rafael García Mozo,
- Teresa González Martínez,
- Mª Dolores Muro Sebastián,
- Marta Balart Carbonell,
- Joan Badia Barnusell,
- Mònica Domingo Puiggròs,
- Corporacio Parc Taulí,
- Josep Figueras Aloy,
- Francesc Botet Mussons,
- Israel Anquela Sanz,
- Gemma Ginovart Galiana,
- Martin Iriondo,
- Laura Castells Vilella,
- Roser Porta,
- Xavier Demestre,
- Silvia Martínez Nadal,
- Cristina de Frutos Martínez,
- María Jesús López Cuesta,
- Dolores Esquivel Mora,
- Joaquín Ortiz Tardío,
- Isabel Benavente,
- Almudena Alonso,
- Ramón Aguilera Olmos,
- Miguel A García Cabezas,
- Mª Dolores Martínez Jiménez,
- Mª Pilar Jaraba Caballero,
- Mª Dolores Ordoñez Díaz,
- Alberto Trujillo Fagundo,
- Lluis Mayol Canals,
- Fermín García-Muñoz Rodrigo,
- Lourdes Urquía Martí,
- María Fernanda Moreno Galdo,
- José Antonio Hurtado Suazo,
- Eduardo Narbona López,
- José Uberos Fernández,
- Miguel A Cortajarena Altuna,
- Oihana Muga,
- David Mora Navarro,
- María Teresa Domínguez,
- Mª Yolanda Ruiz del Prado,
- Inés Esteban Díez,
- María Teresa Palau Benavides,
- Santiago Lapeña,
- Teresa Prada,
- Eduard Soler Mir,
- Araceli Corredera Sánchez,
- Enrique Criado Vega,
- Náyade del Prado,
- Cristina Fernández,
- Lucía Cabanillas Vilaplana,
- Irene Cuadrado Pérez,
- Luisa López Gómez,
- Laura Domingo Comeche,
- Isabel Llana Martín,
- Carmen González Armengod,
- Carmen Muñoz Labián,
- Mª José Santos Muñoz,
- Dorotea Blanco Bravo,
- Vicente Pérez,
- Mª Dolores Elorza Fernández,
- Celia Díaz González,
- Susana Ares Segura,
- Manuela López Azorín,
- Ana Belén Jimenez,
- Tomás Sánchez-Tamayo,
- Elías Tapia Moreno,
- María González,
- Beatriz Vacas del Arco,
- Josefina Márquez Fernández,
- Laura Acosta Gordillo,
- Mercedes Granero Asensio,
- Carmen Macías Díaz,
- Mar Albújar,
- Pedro Fuster Jorge,
- Sabina Romero,
- Ana Belén Escobar Izquierdo,
- Javier Estañ Capell,
- Mª Isabel Izquierdo Macián,
- Mª Mar Montejo Vicente,
- Raquel Izquierdo Caballero,
- Mª Mercedes Martínez,
- Aintzane Euba,
- Amaya Rodríguez Serna,
- Juan María López de Heredia Goya,
- Alberto Pérez Legorburu,
- Ana Gutiérrez Amorós,
- Víctor Manuel Marugán Isabel,
- Natalio Hernández González,
- Segundo Rite Gracia,
- Mª Purificación Ventura Faci,
- Mª Pilar Samper Villagrasa,
- Jiri Kofron,
- Katarina Strand Brodd,
- Andreas Odlind,
- Lars Alberg,
- Sofia Arwehed,
- Ola Hafström,
- Anna Kasemo,
- Karin Nederman,
- Lars Åhman,
- Fredrik Ingemarsson,
- Henrik Petersson,
- Pernilla Thurn,
- Eva Albinsson,
- Bo Selander,
- Thomas Abrahamsson,
- Ingela Heimdahl,
- Kristbjorg Sveinsdottir,
- Erik Wejryd,
- Anna Hedlund,
- Maria Katarina Söderberg,
- Boubou Hallberg,
- Thomas Brune,
- Jens Bäckström,
- Johan Robinson,
- Aijaz Farooqi,
- Erik Normann,
- Magnus Fredriksson,
- Anders Palm,
- Urban Rosenqvist,
- Bengt Walde,
- Cecilia Hagman,
- Andreas Ohlin,
- Rein Florell,
- Agneta Smedsaas-Löfvenberg,
- Philipp Meyer,
- Claudia Anderegg,
- Sven Schulzke,
- Mathias Nelle,
- Bendicht Wagner,
- Grégoire Kaczala,
- Riccardo E Pfister,
- Matthias Roth,
- Martin Stocker,
- Bernhard Laubscher,
- Andreas Malzacher,
- John P Micallef,
- Lukas Hegi,
- Romaine Arlettaz,
- Carlo Dani,
- Patrizio Fiorini,
- Paolo Ghirri,
- Barbara Tomasini,
- Franca Rusconi
Affiliations
- Dirk Bassler
- professor
- Kei Lui
- 12 Department of Newborn Care, Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Sydney, New South Wales, Australia
- Michael Dunn
- director of discovery research
- Victor Samuel Rajadurai
- 1 Department of Neonatology, KK Women`s and Children`s Hospital, Singapore
- Mikael Norman
- 4 Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Alejandro Avila-Alvarez
- 1 Neonatology Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
- Marc Beltempo
- Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
- Mark Adams
- 8 Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Barbara Bajuk
- Critical Care Program, Sydney Children`s Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
- Malcolm Battin
- Auckland City Hospital, Auckland, New Zealand
- Jean-François Tolsa
- Ruben Alvaro
- 1 Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Chuks Nwaesei
- Martine Claveau
- 5 Department of Pediatrics, McGill University, Toronto, Ontario, Canada
- Shoo K Lee
- 2 Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Prakesh S Shah
- 2 Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
- Zenon Cieslak
- Rebecca Sherlock
- Wendy Yee
- Carlos Fajardo
- Zarin Kalapesi
- Koravangattu Sankaran
- Mary Seshia
- 1 Section of Neonatology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Amit Mukerji
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Orlando Da Silva
- Kyong-Soon Lee
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Brigitte Lemyre
- Neonatology, Ottawa Hospital, Ottawa, Ontario, Canada
- Kimberly Dow
- Ermelinda Pelausa
- Keith Barrington
- Christine Drolet
- Centre Hospitalier de lUniversité Laval, Quebec City, Québec, Canada
- Bruno Piedboeuf
- 10 Departement of Pediatrics, Université Laval, Quebec City, Quebec, Canada
- Valerie Bertelle
- 5 Departement of Pediatrics, Université de Sherbooke, Sherbrooke, Quebec, Canada
- Edith Masse
- 5 Department of Pediatrics, Hôpital Fleurimont, Sherbrooke, Québec, Canada
- Roderick Canning
- Hala Makary
- 5 Pediatrics, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
- Cecil Ojah
- Luis Monterrosa
- Jehier Afifi
- Andrzej Kajetanowicz
- lex Doyle
- Roland Broadbent
- 1 Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Ross Haslam
- 6 Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Peter Marshall
- Peter Schmidt
- Psychosomatic Medicine and Psychotherapy, University Medical Center of The Johannes Gutenberg University, Mainz, Germany
- Paul Craven
- Koert De Waal
- Karen Simmer
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Andy Gill
- 2 School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Jacqueline Stack
- School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
- Dan Casalaz
- 13 Neonatal Intensive Care Unit, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Jim Holberton
- Lucy Cooke
- Lyn Downe
- Michael Stewart
- 1 Paediatric Infant Perinatal Emergency Retrieval, Royal Children`s Hospital, Parkville, Victoria, Australia
- Andrew Berry
- Department of Medical Social Sciences, Northwestern University, Evanston, Illinois, USA
- Rod Hunt
- Charles Kilburn
- Tony De Paoli
- Mary Paradisis
- Ingrid Rieger
- Pieter Koorts
- 8 Grantley Stable Neonatal Unit, Royal Brisbane and Women`s Hospital, Herston, Queensland, Australia
- Carl Kuschel
- Andrew Numa
- Hazel Carlisle
- Nadia Badawi
- Cerebral Palsy Alliance, Sydney, New South Wales, Australia
- Guan Koh
- Melissa Luig
- Westmead Department of Neonatology, Westmead Hospital, Westmead, New South Wales, Australia
- Chad Andersen
- 1 Neonatal Medicine, Women`s and Children`s Hospital Adelaide, North Adelaide, South Australia, Australia
- Adrienne Lynn
- Brian Darlow
- Lindsay Mildenhall
- Mariam Buksh
- David Bourchier
- Vaughan Richardson
- Georgina Chambers
- 13 National Perinatal Epidemiology and Statistics Unit, University of New South Wales Centre for Big Data Research in Health, Sydney, New South Wales, Australia
- Robert Halliday
- Grace Centre for Newborn Intensive Care, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Thomas Riedel
- 2 Kantonsspital Graubunden, Chur, Switzerland
- Anne Synnes
- Amir Kugelman
- W Coroleu
- Liisa Lehtonen
- 12 Department of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Brian A Darlow
- 3 Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
- Brian Reichman
- 6 Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
- Stellan Hakansson
- 1 Department of Clinical Sciences, Pediatrics, Umeå University, Umea, Sweden
- Kjell K Helenius
- 9 Department of Pediatrics, Turku University Hospital, Turku, Finland
- Laura San Feliciano
- 11 Division of Neonatology, University Hospital Salamanca, Salamanca, Spain
- Maximo Vento
- 14 Division of Neonatology, Health Research Institute La Fe, Valencia, Spain
- Marco Moroni
- 13 Neonatal Intensive Care Unit, Anna Meyer Children’s University Hospital, Florence, Italy
- Junmin Yang
- 8 Maternal Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
- Adam Buckmaster
- Charles Barfield
- Vijay Shingde
- Shelley Reid
- David Cartwright
- Steven Resnick
- Jutta van den Boom
- Lee Carpenter
- Adele Harrison
- Khalid Aziz
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Akhil Deshpandey
- Sture Andersson
- 1 New Children`s Hospital, Pediatric Research Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Outi Tammela
- Ulla Sankilampi
- 19 Department of Pediatrics, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
- Timo Saarela
- Eli Heymann
- Shmuel Zangen
- Tatyana Smolkin
- Francis Mimouni
- David Bader
- Avi Rothschild
- Zipora Strauss
- Clari Felszer
- Hussam Omari
- Smadar Even Tov-Friedman
- Benjamin Bar-Oz
- Michael Feldman
- Nizar Saad
- Orna Flidel-Rimon
- Meir Weisbrod
- Daniel Lubin
- Ita Litmanovitz
- Eric Shinwell
- Gil Klinger
- deputy director
- Yousif Nijim
- Department of Neonatal, EMMS Hospital, Nazareth, Israel
- Alona Bin-Nun
- Agneta Golan
- Dror Mandel
- 2 Faculty of Medical and Health Sciences, School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Vered Fleisher-Sheffer
- David Kohelet
- Lev Bakhrakh
- José Luis Fernandez-Trisac
- Ma Luz Couce Pico
- María José Fernández Seara
- Andrés Martínez Gutiérrez
- Carolina Vizcaíno
- Miriam Salvador Iglesias
- Honorio Sánchez Zaplana
- Belén Fernández Colomer
- José Enrique García López
- M Rafael García Mozo
- Teresa González Martínez
- Mª Dolores Muro Sebastián
- Marta Balart Carbonell
- Joan Badia Barnusell
- Mònica Domingo Puiggròs
- Corporacio Parc Taulí
- Josep Figueras Aloy
- Francesc Botet Mussons
- Israel Anquela Sanz
- Gemma Ginovart Galiana
- Martin Iriondo
- Laura Castells Vilella
- Roser Porta
- Xavier Demestre
- Silvia Martínez Nadal
- Cristina de Frutos Martínez
- María Jesús López Cuesta
- Dolores Esquivel Mora
- Joaquín Ortiz Tardío
- Isabel Benavente
- Almudena Alonso
- Ramón Aguilera Olmos
- Miguel A García Cabezas
- Mª Dolores Martínez Jiménez
- Mª Pilar Jaraba Caballero
- Mª Dolores Ordoñez Díaz
- Alberto Trujillo Fagundo
- Lluis Mayol Canals
- Fermín García-Muñoz Rodrigo
- Lourdes Urquía Martí
- María Fernanda Moreno Galdo
- José Antonio Hurtado Suazo
- Eduardo Narbona López
- José Uberos Fernández
- Miguel A Cortajarena Altuna
- Oihana Muga
- David Mora Navarro
- María Teresa Domínguez
- Mª Yolanda Ruiz del Prado
- Inés Esteban Díez
- María Teresa Palau Benavides
- Santiago Lapeña
- Teresa Prada
- Eduard Soler Mir
- Araceli Corredera Sánchez
- Enrique Criado Vega
- Náyade del Prado
- Cristina Fernández
- Department of Clinical Infection, Medical Microbiology and Immunology, University of Liverpool, Liverpool, UK
- Lucía Cabanillas Vilaplana
- Irene Cuadrado Pérez
- Luisa López Gómez
- Laura Domingo Comeche
- Isabel Llana Martín
- Carmen González Armengod
- Carmen Muñoz Labián
- Mª José Santos Muñoz
- Dorotea Blanco Bravo
- Vicente Pérez
- Mª Dolores Elorza Fernández
- Celia Díaz González
- Susana Ares Segura
- Manuela López Azorín
- Ana Belén Jimenez
- Pediatrics Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Tomás Sánchez-Tamayo
- Elías Tapia Moreno
- María González
- Supportive Care and Integrative Oncology, Chris O`Brien Lifehouse, Camperdown, New South Wales, Australia
- Beatriz Vacas del Arco
- Josefina Márquez Fernández
- Laura Acosta Gordillo
- Mercedes Granero Asensio
- Carmen Macías Díaz
- Mar Albújar
- Pedro Fuster Jorge
- Sabina Romero
- Ana Belén Escobar Izquierdo
- Javier Estañ Capell
- Mª Isabel Izquierdo Macián
- Mª Mar Montejo Vicente
- Raquel Izquierdo Caballero
- Mª Mercedes Martínez
- Aintzane Euba
- Amaya Rodríguez Serna
- Juan María López de Heredia Goya
- Alberto Pérez Legorburu
- Ana Gutiérrez Amorós
- Víctor Manuel Marugán Isabel
- Natalio Hernández González
- Segundo Rite Gracia
- Mª Purificación Ventura Faci
- Mª Pilar Samper Villagrasa
- Jiri Kofron
- Katarina Strand Brodd
- Andreas Odlind
- Lars Alberg
- Sofia Arwehed
- Ola Hafström
- Anna Kasemo
- Karin Nederman
- Lars Åhman
- Fredrik Ingemarsson
- Henrik Petersson
- Pernilla Thurn
- Eva Albinsson
- Bo Selander
- Thomas Abrahamsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Ingela Heimdahl
- Kristbjorg Sveinsdottir
- Erik Wejryd
- Anna Hedlund
- Maria Katarina Söderberg
- Boubou Hallberg
- Thomas Brune
- Sachs’ Children and Youth Hospital, Stockholm, Sweden
- Jens Bäckström
- Johan Robinson
- Aijaz Farooqi
- 1 Department of Clinical Sciences, Pediatrics, Umeå University, Umea, Sweden
- Erik Normann
- 3 Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Magnus Fredriksson
- Anders Palm
- Urban Rosenqvist
- Bengt Walde
- Cecilia Hagman
- Paediatric Surgery and Neonatology, Skåne University Hospital, Lund, Sweden
- Andreas Ohlin
- Rein Florell
- Agneta Smedsaas-Löfvenberg
- Philipp Meyer
- Claudia Anderegg
- Sven Schulzke
- 25 Department of Neonatology, University Children’s Hospital, Basel, Switzerland
- Mathias Nelle
- Bendicht Wagner
- Grégoire Kaczala
- Riccardo E Pfister
- Neonatal and Pediatric Intensive Care, Geneva University Hospitals, Mother, Child and Adolescent Department, Geneva, Geneva, Switzerland
- Matthias Roth
- Martin Stocker
- Bernhard Laubscher
- Andreas Malzacher
- John P Micallef
- Lukas Hegi
- Romaine Arlettaz
- Carlo Dani
- 9 Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
- Patrizio Fiorini
- Paolo Ghirri
- Barbara Tomasini
- Franca Rusconi
- 4 Unit of Epidemiology, Anna Meyer Children`s University Hospital and Regional Health Agency, Florence, Italy
- DOI
- https://doi.org/10.1136/bmjopen-2019-031086
- Journal volume & issue
-
Vol. 9,
no. 10
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.
