Problem: Necrotizing Enerocolitis (NEC) is one of the leading causes of morbidity and mortality in neonatal intensive care units (NICU), affecting 7% to 14% of premature neonates weighing less than 1500g (Lin et al., 2008). Healthcare costs for the treatment of NEC account for roughly 20% of the 5 billion dollars spent on infants in the NICU annually (Gephart, McGrath, Effken & Halpern, 2012). Nutritional supplements, such as probiotics, may be used prophylactically to prevent NEC in this high-risk population. Objective: A literature review was performed to examine which strains of probiotics show the most potential in reducing the incidence of necrotizing enterocolitis. Method: A literature review was performed using CINAHL, Science Citation Index, Science Direct, Medline, Academic One file, PsychINFO, and PUBMED databases. Key words included enterocolitis, Necrotizing*/PC OR NEC* AND probiotics*. After applying exclusion criteria, 9 articles remained for this review. Results: A variety of probiotic strains used to reduce the incidence of NEC were identified, along with inconsistent times of initiation, number of colony forming units and length of treatment. The most commonly studied probiotic strains include Lactobacillus species, Bifidobacterium species, and Saccharomyces species. After detailed analysis, it appears that a combination of Bifidobacterium species and Lactobacillus species reduce the incidence of NEC from an 8% (Fernández-Carrocera et. al, 2013) reduction up to 100% reduction in the incidence of NEC (Braga, Pontes da Silva, Cabral de Lira, & Lima, 2011). These two species, when combined, were more successful when compared to Saccharomyces species or Lactobacillus species alone. Conclusion: Although there is positive support for the proactive use of probiotics for the reduction of the incidence of NEC in premature neonates, the inconsistencies between studies are a barrier for determination of a specific treatment recommendation. Although the combination of Bifidobacterium species and Lactobacillus species has been shown to have an impact on the reduction of NEC incidence, the research inconsistencies provide a barrier to generalizations for treatment. Additional research that focus on Bifidobactrium species in combination with Lactobacillus species is needed. Furthermore, the use of probiotics as a preventative treatment for NEC has not been thoroughly researched in extremely premature infant populations (gestation). Therefore, although the results are promising, further research is needed before this can be determined as a safe preventative method. The current questions remaining include: when prophylactic treatment should be initiated, how long prophylactic treatment should last, the number of colony forming units to be administered, and what is the long-term impact of probiotic administration on the normal gut flora, if any.

No description available.

No description available.

O objetivo deste estudo foi verificar o comportamento anatomopatológico e expressão imunohistoquímica das proteínas GFAP, Vimentina, COX-2 e Amilóide β em 14 casos de encefalopatias não infecciosas em cães, mais especificamente Meningoencefalite Granulomatosa (MEG), Meningoencefalite Necrotizante (MEN) e Angiopatia Amilóide Cerebral (CAA). Foram coletadas informações clínicas (gênero, raça, idade) e morfológicas (necrose, presença de proteína amilóide, infiltrado inflamatório) dos animais. Para a expressão das proteínas por imunohistoquímica foram confeccionadas lâminas próprias para tal com amostras dos tecidos, juntamente com controles positivos das reações. A avaliação da expressão das proteínas foi de como positivo ou negativo para a marcação para GFAP, Vimentina e COX-2, e para o Aβ seguiu-se a classificação proposta por Olichney (1995), com quatro graduações. Animais SRD (4/14, 28%), de raça Maltês (2/14, 14%), Labrador (2/14, 14%), Poodle (3/14, 21%), Fox Terrier (1/14, 7%), Pug (1/14, 7%) e Bichon Frisè (1/14, 7%) fizeram parte deste estudo, na maioria machos (9/14, 63%). As lesões em todos os casos foram características, sendo que em MEG foi observado manguitos perivasculares abundantes com infiltrado inflamatório disperso pelo parênquima encefálico, caracterizando os quatro casos como de MEG disseminada. Em MEN foi observado o infiltrado inflamatório acompanhado de áreas de necrose, sinais característicos da doença. Nos casos de CAA foi observado agregados proteicos junto aos vasos sanguíneos do encéfalo, confirmados como sendo material amilóide por meio da coloração Vermelho Congo. Quanto a expressão dos antígenos por imunohistoquímica, houve a marcação de todos anticorpos em todos os casos, e, para os casos de CAA, houve uma maioria de casos com classificação 1 (5/6, 83%). Em conclusão: 1. os dados clínicos obtidos reproduzem o comportamento biológico destas doenças em cães; 2. a análise imunohistoquímica das lesões de MEG, MEN e CAA apresentou resultados dentro dos quadros descritos na literatura; 3. a marcação positiva para COX-2 indica um aumento na atividade macrofágica no encéfalo; 4. as marcações de GFAP e Vimentina indicam uma reação das células da glia frente a lesão apresentada; 5. a utilização da imunohistoquímica como ferramenta de diagnóstico para estas doenças é válida. / The goal of this study was to analyze the anatomopathological and immunohistochemical profile for GFAP, Vimentin, COX-2 and β-amyloid in 14 cases of noninfectious encephalopathies in dogs, more specifically Granulomatous Meningoencephalitis (GME), Necrotizing Meningoencephalitis (NME) and Cerebral Amyloid Angiopathy (CAA). Clinical (gender, breed, age) and morphological (necrosis, presence of amyloid protein, inflammatory infiltrate) informations were collected regarding such animals. Microscopy slides with paraffin-embedded sections of tissue were elaborated for the immunohistochemical analysis, as well as positive controls for the reactions. The expressions of the proteins were graded as positive or negative for GFAP, Vimentin and COX-2, and the grading system described by Olichney was used for the β-amyloid. Animals of mixed breed (4/14, 28%), malteses (2/14, 14%), Labrador (2/14, 14%), Poodle (3/14, 21%), Fox Terrier (1/14, 7%), Pug (1/14, 7%) and Bichon Frisè (1/14, 7%) featured in this study, and most of them were males (9/14, 63%). All of the lesions observed were characteristic of such diseases, as perivascular cuffing with an abundant inflammatory infiltrate was observed in GME cases, being all 4 cases considered as disseminated GME. Necrosis, as well as the inflammatory infiltrate, was observed in all NME cases, which is the hallmark of this disease. The deposition of amyloid protein was observed in cases of CAA, which were confirmed by the Congo Red special staining. As for the immunohistochemical expression, all antibodies performed positive staining, and for the β-amyloid there was a predominance of grade 1 cases (5/6, 83%). In conclusion: 1. the clinical data reproduce the biological behavior of such diseases in dogs; 2. the immunohistochemical analysis of the lesions from GME, NME and CAA presented results coherent with those found in the literature; 3. positive staining for COX-2 presented an increased macrophage activity in the brain of those animals; 4. GFAP and Vimentin positive staining indicate a reaction by the glial cells against the presented lesion; 5. immunohistochemistry is a valid diagnostics tool for such diseases.

O objetivo deste estudo foi verificar o comportamento anatomopatológico e expressão imunohistoquímica das proteínas GFAP, Vimentina, COX-2 e Amilóide β em 14 casos de encefalopatias não infecciosas em cães, mais especificamente Meningoencefalite Granulomatosa (MEG), Meningoencefalite Necrotizante (MEN) e Angiopatia Amilóide Cerebral (CAA). Foram coletadas informações clínicas (gênero, raça, idade) e morfológicas (necrose, presença de proteína amilóide, infiltrado inflamatório) dos animais. Para a expressão das proteínas por imunohistoquímica foram confeccionadas lâminas próprias para tal com amostras dos tecidos, juntamente com controles positivos das reações. A avaliação da expressão das proteínas foi de como positivo ou negativo para a marcação para GFAP, Vimentina e COX-2, e para o Aβ seguiu-se a classificação proposta por Olichney (1995), com quatro graduações. Animais SRD (4/14, 28%), de raça Maltês (2/14, 14%), Labrador (2/14, 14%), Poodle (3/14, 21%), Fox Terrier (1/14, 7%), Pug (1/14, 7%) e Bichon Frisè (1/14, 7%) fizeram parte deste estudo, na maioria machos (9/14, 63%). As lesões em todos os casos foram características, sendo que em MEG foi observado manguitos perivasculares abundantes com infiltrado inflamatório disperso pelo parênquima encefálico, caracterizando os quatro casos como de MEG disseminada. Em MEN foi observado o infiltrado inflamatório acompanhado de áreas de necrose, sinais característicos da doença. Nos casos de CAA foi observado agregados proteicos junto aos vasos sanguíneos do encéfalo, confirmados como sendo material amilóide por meio da coloração Vermelho Congo. Quanto a expressão dos antígenos por imunohistoquímica, houve a marcação de todos anticorpos em todos os casos, e, para os casos de CAA, houve uma maioria de casos com classificação 1 (5/6, 83%). Em conclusão: 1. os dados clínicos obtidos reproduzem o comportamento biológico destas doenças em cães; 2. a análise imunohistoquímica das lesões de MEG, MEN e CAA apresentou resultados dentro dos quadros descritos na literatura; 3. a marcação positiva para COX-2 indica um aumento na atividade macrofágica no encéfalo; 4. as marcações de GFAP e Vimentina indicam uma reação das células da glia frente a lesão apresentada; 5. a utilização da imunohistoquímica como ferramenta de diagnóstico para estas doenças é válida. / The goal of this study was to analyze the anatomopathological and immunohistochemical profile for GFAP, Vimentin, COX-2 and β-amyloid in 14 cases of noninfectious encephalopathies in dogs, more specifically Granulomatous Meningoencephalitis (GME), Necrotizing Meningoencephalitis (NME) and Cerebral Amyloid Angiopathy (CAA). Clinical (gender, breed, age) and morphological (necrosis, presence of amyloid protein, inflammatory infiltrate) informations were collected regarding such animals. Microscopy slides with paraffin-embedded sections of tissue were elaborated for the immunohistochemical analysis, as well as positive controls for the reactions. The expressions of the proteins were graded as positive or negative for GFAP, Vimentin and COX-2, and the grading system described by Olichney was used for the β-amyloid. Animals of mixed breed (4/14, 28%), malteses (2/14, 14%), Labrador (2/14, 14%), Poodle (3/14, 21%), Fox Terrier (1/14, 7%), Pug (1/14, 7%) and Bichon Frisè (1/14, 7%) featured in this study, and most of them were males (9/14, 63%). All of the lesions observed were characteristic of such diseases, as perivascular cuffing with an abundant inflammatory infiltrate was observed in GME cases, being all 4 cases considered as disseminated GME. Necrosis, as well as the inflammatory infiltrate, was observed in all NME cases, which is the hallmark of this disease. The deposition of amyloid protein was observed in cases of CAA, which were confirmed by the Congo Red special staining. As for the immunohistochemical expression, all antibodies performed positive staining, and for the β-amyloid there was a predominance of grade 1 cases (5/6, 83%). In conclusion: 1. the clinical data reproduce the biological behavior of such diseases in dogs; 2. the immunohistochemical analysis of the lesions from GME, NME and CAA presented results coherent with those found in the literature; 3. positive staining for COX-2 presented an increased macrophage activity in the brain of those animals; 4. GFAP and Vimentin positive staining indicate a reaction by the glial cells against the presented lesion; 5. immunohistochemistry is a valid diagnostics tool for such diseases.

Objetivo: Avaliar a influência da localização da enterocolite necrosante neonatal na mortalidade de recém-nascidos (RN) submetidos à laparotomia exploradora. Métodos: Estudo de coorte prospectiva de 141 recém-nascidos com ECN submetidos consecutivamente à laparotomia exploradora no período de novembro de 1991 a dezembro de 2005. Foram avaliados dados epidemiológicos, localização e extensão da doença, crescimento intra-uterino e o número de óbitos no período de 60 dias após a cirurgia. Resultados: Setenta e quatro (52,5%) crianças eram do sexo masculino, com peso médio de nascimento de 1.589 ± 665 gramas, com idade gestacional média de 33,6 ± 2,9 semanas. Prematuridade ocorreu em 84,4% (119/141) dos RN. Cinqüenta e sete (40,4%) eram pequenos para a idade gestacional. Óbito ocorreu em 68 crianças (48,2%). Na análise bivariada, observou-se que o comprometimento do jejuno-íleo foi associado com alta mortalidade (20 óbitos - 76,9%; OR = 20; intervalo de confiança de 95% = 4,6 - 96,3; p < 0,001) e que a doença no jejuno estava associada à maior extensão da ECN. Entretanto, no modelo de regressão logística múltipla com controle individual de cada variável, a doença no jejuno-íleo (OR = 0,61; intervalo de confiança de 95% = 0,06 - 6,14; p = 0,68) e no intestino grosso (OR = 2,91; intervalo de confiança de 95% = 0,81 - 10,50; p = 0,10) não foram consideradas fatores de risco para o óbito. Conclusões: Em análise adequada, com controle isolado de cada variável estudada, a mortalidade foi independente da localização da ECN no intestino delgado ou no intestino grosso. Porém, a localização da doença no jejuno foi um marcador de maior extensão da ECN e, conseqüentemente, de pior prognóstico. Extensão difusa da doença e recém-nascidos PIG foram os mais importantes fatores de risco de ocorrência de óbito nesses recém-nascidos submetidos à cirurgia. / Aim of the study: To evaluate the effect of disease site on the mortality rate of newborns with necrotizing enterocolitis (NEC) undergoing exploratory laparotomy. Methods: Prospective cohort of 141 consecutive newborns with NEC who underwent laparotomy from November 1991 to December 2005. The study variables included epidemiologic data, disease site and extent, intrauterine growth, and number of deaths in the 60 days after operation. The protocol was approved by the institution’s Research Ethics Committee. Main results: Seventy-four (52.5%) infants were male. Mean birth weight was 1,589 ± 665 g, and mean gestational age was 33.6 ± 2.9 weeks. One-hundred and nineteen (84.4%) newborns were premature. Small for gestational age was observed in 57 (40.4%). Sixty-eight (48.2%) infants died. Bivariate analysis revealed that involvement of the jejunum and ileum was associated with high mortality rates (20 deaths, 76.9%; OR = 20; 95% 95% CI = 4.6 – 96.3; p < 0.001), and that involvement of the jejunum was associated with greater disease extent. After controlling for individual variables, logistic regression showed that the mortality associated with jejunum and ileum involvement (OR = 0.61; 95% CI = 0.06 - 6.14; p = 0.68) did not differ from that associated with large bowel involvement (OR = 2.91; 95% CI = 0.81 – 10.50; p = 0.10); however, jejunum involvement remained significantly associated with disease extent. Conclusions: NEC-related mortality in newborns undergoing laparotomy was not influenced by disease site (small or large bowel). However, jejunum involvement was a marker of greater disease extent and therefore of poor prognosis. Diffuse disease extent and small for gestational age were the most important markers of risk of death in NEC newborns submitted to surgery.

Objetivo: Avaliar a influência da localização da enterocolite necrosante neonatal na mortalidade de recém-nascidos (RN) submetidos à laparotomia exploradora. Métodos: Estudo de coorte prospectiva de 141 recém-nascidos com ECN submetidos consecutivamente à laparotomia exploradora no período de novembro de 1991 a dezembro de 2005. Foram avaliados dados epidemiológicos, localização e extensão da doença, crescimento intra-uterino e o número de óbitos no período de 60 dias após a cirurgia. Resultados: Setenta e quatro (52,5%) crianças eram do sexo masculino, com peso médio de nascimento de 1.589 ± 665 gramas, com idade gestacional média de 33,6 ± 2,9 semanas. Prematuridade ocorreu em 84,4% (119/141) dos RN. Cinqüenta e sete (40,4%) eram pequenos para a idade gestacional. Óbito ocorreu em 68 crianças (48,2%). Na análise bivariada, observou-se que o comprometimento do jejuno-íleo foi associado com alta mortalidade (20 óbitos - 76,9%; OR = 20; intervalo de confiança de 95% = 4,6 - 96,3; p < 0,001) e que a doença no jejuno estava associada à maior extensão da ECN. Entretanto, no modelo de regressão logística múltipla com controle individual de cada variável, a doença no jejuno-íleo (OR = 0,61; intervalo de confiança de 95% = 0,06 - 6,14; p = 0,68) e no intestino grosso (OR = 2,91; intervalo de confiança de 95% = 0,81 - 10,50; p = 0,10) não foram consideradas fatores de risco para o óbito. Conclusões: Em análise adequada, com controle isolado de cada variável estudada, a mortalidade foi independente da localização da ECN no intestino delgado ou no intestino grosso. Porém, a localização da doença no jejuno foi um marcador de maior extensão da ECN e, conseqüentemente, de pior prognóstico. Extensão difusa da doença e recém-nascidos PIG foram os mais importantes fatores de risco de ocorrência de óbito nesses recém-nascidos submetidos à cirurgia. / Aim of the study: To evaluate the effect of disease site on the mortality rate of newborns with necrotizing enterocolitis (NEC) undergoing exploratory laparotomy. Methods: Prospective cohort of 141 consecutive newborns with NEC who underwent laparotomy from November 1991 to December 2005. The study variables included epidemiologic data, disease site and extent, intrauterine growth, and number of deaths in the 60 days after operation. The protocol was approved by the institution’s Research Ethics Committee. Main results: Seventy-four (52.5%) infants were male. Mean birth weight was 1,589 ± 665 g, and mean gestational age was 33.6 ± 2.9 weeks. One-hundred and nineteen (84.4%) newborns were premature. Small for gestational age was observed in 57 (40.4%). Sixty-eight (48.2%) infants died. Bivariate analysis revealed that involvement of the jejunum and ileum was associated with high mortality rates (20 deaths, 76.9%; OR = 20; 95% 95% CI = 4.6 – 96.3; p < 0.001), and that involvement of the jejunum was associated with greater disease extent. After controlling for individual variables, logistic regression showed that the mortality associated with jejunum and ileum involvement (OR = 0.61; 95% CI = 0.06 - 6.14; p = 0.68) did not differ from that associated with large bowel involvement (OR = 2.91; 95% CI = 0.81 – 10.50; p = 0.10); however, jejunum involvement remained significantly associated with disease extent. Conclusions: NEC-related mortality in newborns undergoing laparotomy was not influenced by disease site (small or large bowel). However, jejunum involvement was a marker of greater disease extent and therefore of poor prognosis. Diffuse disease extent and small for gestational age were the most important markers of risk of death in NEC newborns submitted to surgery.

Objetivo: Avaliar a influência da localização da enterocolite necrosante neonatal na mortalidade de recém-nascidos (RN) submetidos à laparotomia exploradora. Métodos: Estudo de coorte prospectiva de 141 recém-nascidos com ECN submetidos consecutivamente à laparotomia exploradora no período de novembro de 1991 a dezembro de 2005. Foram avaliados dados epidemiológicos, localização e extensão da doença, crescimento intra-uterino e o número de óbitos no período de 60 dias após a cirurgia. Resultados: Setenta e quatro (52,5%) crianças eram do sexo masculino, com peso médio de nascimento de 1.589 ± 665 gramas, com idade gestacional média de 33,6 ± 2,9 semanas. Prematuridade ocorreu em 84,4% (119/141) dos RN. Cinqüenta e sete (40,4%) eram pequenos para a idade gestacional. Óbito ocorreu em 68 crianças (48,2%). Na análise bivariada, observou-se que o comprometimento do jejuno-íleo foi associado com alta mortalidade (20 óbitos - 76,9%; OR = 20; intervalo de confiança de 95% = 4,6 - 96,3; p < 0,001) e que a doença no jejuno estava associada à maior extensão da ECN. Entretanto, no modelo de regressão logística múltipla com controle individual de cada variável, a doença no jejuno-íleo (OR = 0,61; intervalo de confiança de 95% = 0,06 - 6,14; p = 0,68) e no intestino grosso (OR = 2,91; intervalo de confiança de 95% = 0,81 - 10,50; p = 0,10) não foram consideradas fatores de risco para o óbito. Conclusões: Em análise adequada, com controle isolado de cada variável estudada, a mortalidade foi independente da localização da ECN no intestino delgado ou no intestino grosso. Porém, a localização da doença no jejuno foi um marcador de maior extensão da ECN e, conseqüentemente, de pior prognóstico. Extensão difusa da doença e recém-nascidos PIG foram os mais importantes fatores de risco de ocorrência de óbito nesses recém-nascidos submetidos à cirurgia. / Aim of the study: To evaluate the effect of disease site on the mortality rate of newborns with necrotizing enterocolitis (NEC) undergoing exploratory laparotomy. Methods: Prospective cohort of 141 consecutive newborns with NEC who underwent laparotomy from November 1991 to December 2005. The study variables included epidemiologic data, disease site and extent, intrauterine growth, and number of deaths in the 60 days after operation. The protocol was approved by the institution’s Research Ethics Committee. Main results: Seventy-four (52.5%) infants were male. Mean birth weight was 1,589 ± 665 g, and mean gestational age was 33.6 ± 2.9 weeks. One-hundred and nineteen (84.4%) newborns were premature. Small for gestational age was observed in 57 (40.4%). Sixty-eight (48.2%) infants died. Bivariate analysis revealed that involvement of the jejunum and ileum was associated with high mortality rates (20 deaths, 76.9%; OR = 20; 95% 95% CI = 4.6 – 96.3; p < 0.001), and that involvement of the jejunum was associated with greater disease extent. After controlling for individual variables, logistic regression showed that the mortality associated with jejunum and ileum involvement (OR = 0.61; 95% CI = 0.06 - 6.14; p = 0.68) did not differ from that associated with large bowel involvement (OR = 2.91; 95% CI = 0.81 – 10.50; p = 0.10); however, jejunum involvement remained significantly associated with disease extent. Conclusions: NEC-related mortality in newborns undergoing laparotomy was not influenced by disease site (small or large bowel). However, jejunum involvement was a marker of greater disease extent and therefore of poor prognosis. Diffuse disease extent and small for gestational age were the most important markers of risk of death in NEC newborns submitted to surgery.

Made available in DSpace on 2016-08-18T17:27:37Z (GMT). No. of bitstreams: 1 Dissertacao CAMILA MARIA SANTANA COSTA BUNA.pdf: 1078836 bytes, checksum: 614336d682cc50d8f7758d2f5265a615 (MD5) Previous issue date: 2015-07-06 / The Necrotizing enterocolitis (ECN) is a severe gastrointestinal illness caused by multiple factors and is among the leading causes of neonatal mortality in the Neonatal Intensive Care Unit of the Environment (NICU). The incidence of NEC is inversely proportional to gestational age and birth weight, reaching 12% of children weighing less than 1500g and triggering death in 30% of casos.Tem up to analyze the occurrence of ECN and associated factors its development in newborns (NB) with low weight. It is an epidemiological case-control study, conducted from March 1, 2014 to June 30, 2015, in two NICUs in Sao Luis, MA. The sample size was calculated considering a case to three controls (1:3), establishing confidence level of 95% and power of 80% study, sufficient to detect an OR = 2.5, making 236 newborns (RN) underweight, and 59 infants with NEC diagnoses (case group) and 177 infants without NEC (control group). In analyzing the data maternal variables (gestational period and the type of delivery) and newborn (birth and hospitalization) were organized in six blocks, arranged in a hierarchical structure, and analyzed in STATA 11.0 program. The differences between means were assessed by Student's t-test, whereas the differences between the medians by Man Whitney test. It was considered as the dependent variable, the ECN, and as independent, maternal and neonatal variables. Univariate analysis was performed between independent variables of two groups: case and control, estimated the OR values, with reference category OR = 1, built the confidence intervals of 95% and certain values of p. In the hierarchical analysis was carried out by the group of variables in levels according to influence the outcome. Of the 59 cases of NEC, 61.02% were female, with a median of 45 days hospital stay; and 177 controls without ECN, 54.55% were male, with a median hospital stay of 19.5 days. As for the clinical outcome of cases of NEC, 40.68% progressed to death. At the end of hierarchical analysis remained statistically significant association, the use of antenatal corticosteroids (OR = 2.90; p <0.001), reduced amniotic fluid (OR = 2.03;p<0.001), resuscitation at birth (OR = 1, 35, p = 0.010), birth weight ≤1500g (OR = 3.32, p <0.001), transfusions (OR = 2.11, p = 0.040) and the use of surfactant (OR = 2.41, p = 0.020). It concludes that maternal aspects related to pregnancy and neonatal concerning the birth and hospitalization may be influencing the appearance of NEC. / A Enterocolite Necrosante(ECN) é uma grave enfermidade gastrintestinal, de causa multifatorial e está entre as principais causas de mortalidade neonatal no ambiente da Unidade de Terapia Intensiva Neonatal (UTIN). A incidência da ECN é inversamente proporcional à idade gestacional e o peso de nascimento, atingindo 12% das crianças com peso inferior a 1500g e desencadeando o óbito em 30% dos casos.Tem-se como objetivo analisar a ocorrência de ECN e os fatores associados ao seu desenvolvimento em recém-nascidos (RN)de baixo peso. Trata-se de um estudo epidemiológico tipo caso controle, realizado no período de 01 de março de 2014 a 30 de junho de 2015, em duas UTINs de São Luís-MA. O tamanho da amostra foi calculado considerando um caso para três controles (1:3), estabelecendo nível de confiança de 95% e poder do estudo de 80%,suficiente para detectar um OR=2,5, perfazendo 236 recém-nascidos (RN) de baixo peso, sendo 59 RN com diagnósticos de ECN (grupo caso) e 177 RN sem ECN (grupo controle). Na análise dos dados as variáveis maternas (período gestacional e o tipo de parto) e neonatais (nascimento e hospitalização) foram organizadas em seis blocos e dispostas em uma estrutura hierarquizada, e analisadas no programa STATA 11.0. As diferenças entre as médias foram avaliadas pelo teste T-Student, enquanto que as diferenças entre as medianas pelo teste de Man Whitney. Considerou-se como variável resposta, a ECN, e como independentes, as variáveis maternas e neonatais. Foi realizada análise univariada entre as variáveis independentes dos doisgrupos: caso e controle, estimados os valores das OR, tendo como categoria de referência OR=1, construídos os intervalos de confiança de 95% e determinados os valores de p. Na análise hierarquizada foi realizadoo agrupamento das variáveis em níveis segundo a influência no desfecho. Dos 59 casos de ECN, 61,02% eram do sexo feminino,com mediana do tempo de hospitalização de 45 dias; edos 177 controles sem ECN, 54,55% eram do sexo masculino, com mediana do tempo de hospitalização de 19,5 dias. Quanto ao desfecho clínico dos casos de ECN, 40,68% evoluíram a óbito. Ao final da análise hierarquizada mantiveram associação estatisticamente significante, o uso de corticóide antenatal (OR=2,90; p<0,001), líquido amniótico reduzido (OR=2,03;p<0,001), reanimação ao nascimento (OR=1,35; p=0,010), peso ao nascimento ≤1500g (OR=3,32;p<0,001), transfusão (OR=2,11;p=0,040) e uso de surfactante (OR=2,41;p=0,020). Conclui-se que os aspectos maternos relacionados ao período gestacional e os neonatais referentes ao nascimento e hospitalização podem estarinfluenciando no aparecimento da ECN.

Background: Necrotizing pancreatitis is a life-threatening presentation of acute pancreatitis. The mortality of 20–80% initially depends on the persistence of organ failure and systemic inflammatory response syndrome (SIRS) and, in the later course of the disease, on secondary infection of the necrosis. The questions whether prophylactic antibiotics aiming to prevent this infection should be administered and which antibiotic is the best to use, as well as the problem of fungal infection under antibiotic treatment are still intriguing and insufficiently solved. Methods: A search of the literature using PubMed was carried out, supplemented by a review of the programmes of the Digestive Disease Week (DDW) and the United European Gastroenterology Week (UEGW). Results: Despite the widely practised prophylactic antibiotic administration in severe pancreatitis, no evidence for the benefit of this strategy exists. One of the drawbacks might be a tendency for disastrous fungal infection under prophylactic antibiotics. Bacterial translocation from the gut in the second week after the onset of symptoms is the major source for infection of pancreatic necrosis and provides a clear indication for antibiotic treatment. However, routine fine-needle aspiration for a calculated antibiotic therapy cannot be recommended, and all other tests offer only indirect signs. Important factors such as enteral versus parenteral feeding and the method of necrosectomy are mostly neglected in the trials but seem to be essential for the outcome of the patient. Conclusions: Even though most meta-analyses including the newer double-blind, placebo-controlled trials on prophylactic antibiotics showed no beneficial effects in the prevention of infection of necrosis and/or outcome of the patients, this strategy is still widely used in clinical routine. Since nearly all trials published so far show systematic problems (i.e. inaccurate definition of the severity of the disease, poor statistical testing, and neglect of differences in the route of nutrition), there is a need for randomized controlled prospective trials with exact definitions of the disease. / Hintergrund: Die nekrotisierende Pankreatitis weist eine Mortalität von 20–80% auf. Initial ist vor allem das Ausmaß des Organversagens entscheidend für die Prognose des Patienten. In der zweiten Krankheitswoche stellt dann die sekundäre Infektion der Nekrosen durch die Translokation von Darmkeimen das entscheidende Problem dar. Zur Vermeidung einer solchen Infektion werden klinisch sehr häufig Breitspektrumantibioktika prophylaktisch eingesetzt. Dies wird aber zunehmend kritisch diskutiert, und es existieren kontroverse Empfehlungen. Methoden: Eine Literaturrecherche unter Einbeziehung von PubMed und der Programme der Digestive Disease Week (DDW) und der United European Gastroenterology Week (UEGW) wurde durchgeführt. Ergebnisse: Die meisten Studien können den prophylaktischen Einsatz von Antibiotika bei der schweren Pankreatitis nicht rechtfertigen. Einige Studien belegen vielmehr eine Selektion resistenter Keime und vor allem auch eine erhöhte Rate von schwer therapierbaren Pilzinfektionen unter einer solchen Therapie. Daher sollte erst nach dem Nachweis einer Nekroseinfektion mit einer Antibiotikatherapie begonnen werden, wobei keine Routine-Feinnadelpunktion der Nekrose zum Keimnachweis durchgeführt werden sollte. Es stehen daher nur indirekte, meist bildgebende Verfahren für den Infektionsnachweis zur Verfügung. Entscheidende Faktoren wie die enterale Ernährung und die Methode der Nekrosektomie wurden bisher bei den meisten Studien vernachlässigt, scheinen aber essenziell für das Behandlungsergebnis des Patienten zu sein. Schlussfolgerungen: Die meisten publizierten Studien weisen eine sehr heterogene Definition der Erkrankung, uneinheitliche Behandlungsprotokolle und Ungenauigkeiten bei der statistischen Testung auf. Gerade entscheidende Faktoren wie die enterale Ernährung werden größtenteils komplett vernachlässigt. Es besteht daher ein Bedarf für randomisierte placebokontrollierte Studien, die diese Probleme berücksichtigen und suffiziente Schlussfolgerungen zur Antibiotikatherapie der schweren Pankreatitis zulassen.