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In the last decade, it has become increasingly clear that necrotizing enterocolitis (NEC) is neither a uniform nor a well-defined disease entity. There are many factors that are forcing this unwelcome realization upon the neonatal and pediatric surgery communities. In the course of this manuscript we will review the history and the physical findings of the disparate etiologies of acquired neonatal intestinal diseases (ANIDs), some which do lead to the common final pathology of NEC and some which do not. New guidelines for distinguishing between ANIDs will also be suggested.Journal of Perinatology (2007) 27, 661–671; doi:10.1038/sj.jp.7211782; published online 5 July 2007 [ABSTRACT FROM AUTHOR]

Objective:To evaluate the relationship between enteral water infusion for hypernatremia and significant intestinal morbidity in infants 1000 grams.Study design:This is a retrospective study of 321 infants 1000 g birth weight. Infants were grouped by the highest serum sodium (mmol/l) during the first 14 days of life as follows: <150 (normal control), 150 (high sodium control), 150 and treated with sterile water (study group). Significant intestinal morbidity was defined as probable or proven necrotizing enterocolitis or spontaneous intestinal perforation. Statistical analysis included Student's t test for continuous variables and χ2 with Yeats correction for frequency variables. Multivariate logistic regression analysis was then performed to evaluate confounding variables among groups.Results:The incidence of intestinal morbidity was significantly higher in the high sodium-water treated group compared to each of the other groups (13/33 (38%) for high sodium-water versus 16/100 (16%) for high sodium control and 18/188 (10%) for normal sodium control, P<0.01 χ2). Logistic regression analysis indicated that enteral water and hydrocortisone were risk factors for significant intestinal morbidity.Conclusions:Enteral sterile water for hypernatremia appears to be associated with significant intestinal morbidity in infants 1000 g. Hydrocortisone is also a risk factor.Journal of Perinatology (2007) 27, 32–38. doi:10.1038/sj.jp.7211622 [ABSTRACT FROM AUTHOR]

Background:Spontaneous intestinal perforation (SIP) is increasingly common in the premature infant and is associated with significant morbidity. Indomethacin use has been implicated as a co-risk factor for SIP when combined with glucocorticoids, but previous evidence argued against indomethacin being an independent risk factor when used prophylactically.Objectives:(1) To establish a homogeneous cohort of SIP patients in a national data set and to contrast them to patients with surgical necrotizing enterocolitis (NEC). (2) To test the hypothesis that early post-natal indomethacin is independently associated with SIP.Methods:A large de-identified data set was retrospectively queried by diagnosis, and then multiple antenatal and post-natal variables were tested by both univariate and multivariate analysis to identify associations with SIP. Sub-analyses were also performed to look at the timing of drug administration.Results:There were 2105 patients evaluated in the data set. Patients were divided into matched controls (n=581), those with SIP without report of NEC (n=633) and those with NEC requiring surgery (n=891). Infants with SIP were more likely to have a patent ductus arteriosus and more likely to be treated with vasopressors than either control or NEC patients. Compared to infants with NEC, patients with SIP were smaller, less mature and required more support. SIP was also diagnosed earlier than NEC (median of 7 vs 15 days). Patients with SIP were more likely to be treated with indomethacin, hydrocortisone or both on days of life 0–3 than controls.Conclusions:(1) Surgical NEC and SIP have significant differences in presentation, demographics and morbidity. (2) A detailed look at drug timing revealed that early post-natal indomethacin is independently associated with SIP.Journal of Perinatology (2006) 26, 93–99. doi:10.1038/sj.jp.7211429; published online 1 December 2005 [ABSTRACT FROM AUTHOR]