The Experts below are selected from a list of 267 Experts worldwide ranked by ideXlab platform

Karl G Sylvester - One of the best experts on this subject based on the ideXlab platform.

  • effect of deregionalized care on mortality in very low birth weight infants with necrotizing Enterocolitis
    JAMA Pediatrics, 2015
    Co-Authors: Zachary J Kastenberg, Karl G Sylvester, Jochen Profit, Jeffrey B Gould
    Abstract:

    Importance There has been a significant expansion in the number of low-level and midlevel neonatal intensive care units (NICUs) in recent decades. Infants with necrotizing Enterocolitis represent a high-risk subgroup of the very low-birth-weight (VLBW) ( Objectives To describe the current trend toward deregionalization and to test the hypothesis that infants with necrotizing Enterocolitis represent a particularly high-risk subgroup of the VLBW population that would benefit from early identification, increased intensity of early management, and possible targeted triage to tertiary hospitals. Design, Setting, and Participants A retrospective cohort study was conducted of NICUs in California. We used data collected by the California Perinatal Quality Care Collaborative from 2005 to 2011 to assess mortality rates among a population-based sample of 30 566 VLBW infants, 1879 with necrotizing Enterocolitis, according to the level of care and VLBW case volume at the hospital of birth. Exposures Level and volume of neonatal intensive care at the hospital of birth. Main Outcomes and Measures In-hospital mortality. Results There was a persistent trend toward deregionalization during the study period and mortality rates varied according to the level of care. High-level, high-volume (level IIIB with >100 VLBW cases per year and level IIIC) hospitals achieved the lowest risk-adjusted mortality. Infants with necrotizing Enterocolitis born into midlevel hospitals (low-volume level IIIB and level IIIA NICUs) had odds of death ranging from 1.42 (95% CI, 1.08-1.87) to 1.51 (95% CI, 1.05-2.15, respectively). In the final year of the study, just 28.6% of the infants with necrotizing Enterocolitis were born into high-level, high-volume hospitals. For infants born into lower level centers, transfer to a higher level of care frequently occurred well into the third week of life. Conclusions and Relevance These findings represent an immediate opportunity for local quality improvement initiatives and potential impetus for the regionalization of important NICU resources.

  • laparotomy versus peritoneal drainage for necrotizing Enterocolitis and perforation
    The New England Journal of Medicine, 2006
    Co-Authors: Lawrence R Moss, Reed A. Dimmitt, Douglas C Barnhart, Karl G Sylvester, Rebeccah L Brown, David M Powell, Saleem Islam, Jacob C Langer, Thomas T Sato, Mary L Brandt
    Abstract:

    Background Perforated necrotizing Enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outcomes of primary peritoneal drainage with laparotomy and bowel resection in preterm infants with perforated necrotizing Enterocolitis. Methods We randomly assigned 117 preterm infants (delivered before 34 weeks of gestation) with birth weights less than 1500 g and perforated necrotizing Enterocolitis at 15 pediatric centers to undergo primary peritoneal drainage or laparotomy with bowel resection. Postoperative care was standardized. The primary outcome was survival at 90 days postoperatively. Secondary outcomes included dependence on parenteral nutrition 90 days postoperatively and length of hospital stay. Results At 90 days postoperatively, 19 of 55 infants assigned to primary peritoneal drainage had died (34.5 percent), as compared with 22 of 62 infants assigned to laparotomy (35.5 percent, P...

Michele C. Walsh - One of the best experts on this subject based on the ideXlab platform.

Andrew S Kemp - One of the best experts on this subject based on the ideXlab platform.

  • food protein induced Enterocolitis syndrome 16 year experience
    Pediatrics, 2009
    Co-Authors: Sam Mehr, Alyson Kakakios, Katie Frith, Andrew S Kemp
    Abstract:

    OBJECTIVE: The goal was to examine the demographic characteristics, causative foods, clinical features, treatments, and outcomes for children presenting with acute food protein-induced Enterocolitis syndrome. METHODS: This was a retrospective study of children with food protein-induced Enterocolitis syndrome who presented to the Children's Hospital at Westmead (Sydney, Australia) over 16 years. RESULTS: Thirty-five children experienced 66 episodes of food protein-induced Enterocolitis syndrome. The mean age at initial presentation was 5.5 months. Children frequently experienced multiple episodes before a correct diagnosis was made. Twenty-nine children reacted to 1 food, and 6 reacted to 2 foods. Causative foods for the 35 children were rice (n = 14), soy (n = 12), cow's milk (n = 7), vegetables and fruits (n = 3), meats (n = 2), oats (n = 2), and fish (n = 1). In the 66 episodes, vomiting was the most common clinical feature (100%), followed by lethargy (85%), pallor (67%), and diarrhea (24%). A temperature of 500 x 10(9) cells per L was recorded for 63% of episodes with blood count results. Only 2 of the 19 children who presented to an emergency department with their initial reactions were discharged with correct diagnoses. Additional investigations of food protein-induced Enterocolitis syndrome episodes presenting to the hospital were common, with 34% of patients undergoing abdominal imaging, 28% undergoing a septic evaluation, and 22% having a surgical consultation. Prognosis was good, with high rates of resolution for the 2 most common food triggers (ie, rice and soy) by 3 years of age. CONCLUSIONS: Misdiagnosis and delays in diagnosis for children with food protein-induced Enterocolitis syndrome were common, leading many children to undergo unnecessary, often painful investigations. Decreased body temperature and thrombocytosis emerge as additional features of the syndrome.

Barbara J Stoll - One of the best experts on this subject based on the ideXlab platform.

  • neurodevelopmental outcomes of extremely low birth weight infants with spontaneous intestinal perforation or surgical necrotizing Enterocolitis
    Journal of Perinatology, 2014
    Co-Authors: Rajan Wadhawan, Barbara J Stoll, William Oh, Susan R Hintz, Martin L Blakely, Edward F Bell, Shampa Saha, Abbot R Laptook, Seetha Shankaran, Michele C. Walsh
    Abstract:

    Neurodevelopmental outcomes of extremely low birth weight infants with spontaneous intestinal perforation or surgical necrotizing Enterocolitis

  • prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing Enterocolitis and death for extremely low birth weight infants
    Pediatrics, 2009
    Co-Authors: Michael C Cotten, Barbara J Stoll, Sarah Taylor, Ronald N Goldberg, Nellie I Hansen, Pablo J Sanchez, Namasivayam Ambalavanan, Daniel K Benjamin
    Abstract:

    OBJECTIVES. Our objectives were to identify factors associated with the duration of the first antibiotic course initiated in the first 3 postnatal days and to assess associations between the duration of the initial antibiotic course and subsequent necrotizing Enterocolitis or death in extremely low birth weight infants with sterile initial postnatal culture results. METHODS. We conducted a retrospective cohort analysis of extremely low birth weight infants admitted to tertiary centers in 1998–2001. We defined initial empirical antibiotic treatment duration as continuous days of antibiotic therapy started in the first 3 postnatal days with sterile culture results. We used descriptive statistics to characterize center practice, bivariate analyses to identify factors associated with prolonged empirical antibiotic therapy (≥5 days), and multivariate analyses to evaluate associations between therapy duration, prolonged empirical therapy, and subsequent necrotizing Enterocolitis or death. RESULTS. Of 5693 extremely low birth weight infants admitted to 19 centers, 4039 (71%) survived >5 days, received initial empirical antibiotic treatment, and had sterile initial culture results through the first 3 postnatal days. The median therapy duration was 5 days (range: 1–36 days); 2147 infants (53%) received prolonged empirical therapy (center range: 27%–85%). Infants who received prolonged therapy were less mature, had lower Apgar scores, and were more likely to be black. In multivariate analyses adjusted for these factors and center, prolonged therapy was associated with increased odds of necrotizing Enterocolitis or death and of death. Each empirical treatment day was associated with increased odds of death, necrotizing Enterocolitis, and the composite measure of necrotizing Enterocolitis or death. CONCLUSION. Prolonged initial empirical antibiotic therapy may be associated with increased risk of necrotizing Enterocolitis or death and should be used with caution.

  • Necrotising Enterocolitis.
    Lancet (London England), 2006
    Co-Authors: Barbara J Stoll
    Abstract:

    Necrotising Enterocolitis is one of the most common gastrointestinal emergencies in newborn infants. Here we review the epidemiology, clinical presentation, and pathophysiology of the disease, as well as strategies for diagnosis, management, and prevention. Necrotising Enterocolitis is one of the most devastating and unpredictable diseases affecting premature infants. Despite decades of research, its pathogenesis remains unclear; diagnosis can be difficult; and treatment is challenging. We will need to improve our understanding of intestinal defences in premature infants, dietary and bacterial factors, and genetic effects that could predispose infants to necrotising Enterocolitis before we can develop new strategies for prevention and treatment.

Rajan Wadhawan - One of the best experts on this subject based on the ideXlab platform.