biostudies-literatureAdams MCanadian Institutes of Health ResearchCIHRe031086https://www.ebi.ac.uk/biostudies/studies/S-EPMC6797308biostudies-literatureUnknown9(10)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.BMJ openPreventive strategies and factors associated with surgically treated necrotising enterocolitis in extremely preterm infants: an international unit survey linked with retrospective cohort data analysis.PMC6797308CTP 87518APR-126340Esteban Diez IBenavente IHeymann EKilburn CGonzalez MPerez ICVilaplana LCHalliday RReichman BGolan AVento MFleisher-Sheffer VArmengod CGGaliana GGNadal SMSelander BDowne LAsensio MGPaoli TZangen SKohelet DCortajarena Altuna MABeltempo MOlmos RAMoreno Galdo MFFernandez Seara MJMartinez MMFredriksson MSegura SAFlorell RMoroni MKugelman AMartinez Jimenez MDGonzalez CDAlbujar MPalau Benavides MTSanz IAAlvaro RFeldman MPrado NDElorza Fernandez MDCaballero RIMuga OPelausa EBin-Nun ABakhrakh LBattin MLee SKKuschel CBader DJaraba Caballero MPComeche LDLui KSherlock RPrada TMalzacher AEstan Capell JWaal KCanals LMSanchez-Tamayo TGill ABuksh MCarlisle HBarfield CSaarela TLapena SSveinsdottir KBroadbent RGomez LLNederman KAfifi JRieger IMora DEStack JMussons FBRuiz Del Prado MYLemyre BFarooqi AVentura Faci MPVizcaino CStocker MNuma AWagner BHunt RLuig MFiorini PSanchez ACMeyer PDani CRafael Garcia Mozo MRosenqvist UDunn MClaveau MTomasini BBoom JVDMukerji AFagundo ATOhlin AAndersen CMuro Sebastian MDFernandez-Trisac JLDel Arco BVTov-Friedman SEHallberg BSmolkin TReid SKofron JAlbinsson EKaczala GAloy JFKlinger GRomero SKoh GBadawi NShah PSSerna ARThurn PGutierrez AMMasse ENormann EPfister REPerez VShingde VBarnusell JBSeshia MHedlund AStrauss ZFlidel-Rimon OLubin DShinwell EFelszer CMartinez CFAzorin MLLopez de Heredia Goya JMDoyle LAmoros AGPalm ANelle MAhman LPetersson HSankilampi UMartinez TGNavarro DMCooke LSilva ODArwehed SFajardo CHafstrom OStewart MAlonso ABuckmaster AKalapesi ZRodrigo FGLopez Cuesta MJAziz KSmedsaas-Lofvenberg AAndersson SDeshpandey AMandel DLitmanovitz IEuba AGonzalez NHMarugan Isabel VMKajetanowicz ACartwright DCraven PGhirri PBrune TRajadurai VSIglesias MSOdlind ARichardson VRothschild ASantos Munoz MJZaplana HSBravo DBTolsa JFMoreno ETRoth MAvila-Alvarez ASan Feliciano LGarcia Lopez JEIriondo MBajuk BCanning RHakansson SVilella LCLabian CMHeimdahl IColomer BFKoorts PBackstrom JCieslak ZFernandez CPiedboeuf BIngemarsson FAdams MLee KSLopez ENBar-Oz BSchulzke SGracia SRDrolet CRusconi FHaslam RMimouni FCarpenter LSankaran KTauli CPEscobar Izquierdo ABHolberton JLynn AMarti LUResnick STardio JONwaesei CMartin ILNijim YSchmidt PMicallef JPWejryd EDarlow BBassler DDominguez MTYang JMakary HAlberg LCarbonell MBYee WDow KJorge PFBerry AGarcia Cabezas MASimmer KCoroleu WHegi LMir ESIzquierdo Macian MIVega ECBertelle VBarrington KKasemo AHurtado Suazo JAWalde BPico MLCChambers GArlettaz RBrodd KSDemestre XRiedel TAbrahamsson TPuiggros MDPorta RJimenez ABMonterrosa LHagman CDiaz CMNorman MSynnes AHarrison APillow JOjah CWeisbrod MSaad NMontejo Vicente MMOmari HLehtonen LParadisis MOrdonez Diaz MDRobinson JDarlow BAAnderegg CInternational Network for EvaluatingOutcomes (iNeo) of NeonatesGordillo LAMarshall PFernandez JMFernandez JUHelenius KKCasalaz DTammela OLegorburu APSamper Villagrasa MPBourchier DMildenhall LSoderberg MKLaubscher BfalsePreventive strategies and factors associated with surgically treated necrotising enterocolitis in extremely preterm infants: an international unit survey linked with retrospective cohort data analysis.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.2019-01-01T00:00:00Z2019 Oct2024-11-06T20:17:53.299Z2019-11-07T08:04:52ZS-EPMC67973083161579910.1136/bmjopen-2019-031086