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Selected Publication:

Klobassa, D.
Placebo controlled introduction of prophylactic supplementation of probiotics to decrease the incidence of Necrotizing Enterocolitis (NEC) at Dhulikhel Hospital in Nepal
[ Diplomarbeit ] Graz Medical University; 2012. pp. 73 [OPEN ACCESS]


Authors Med Uni Graz:
Kohlfürst Daniela
Urlesberger Berndt

Context: Necrotizing Enterocolitis (NEC) is the most common life-threatening emergency of the gastrointestinal tract in the newborn period, especially affecting preterm newborns. Results from previous studies give evidence that the prophylactic supplementation of probiotics leads to a decrease in the incidence of NEC. Objectives: This study project consists of two parts: a retrospective study, which aims to analyze NEC cases in the past and a prospective controlled study, which aims to evaluate the effect of probiotic supplementation in preterm newborns at Dhulikhel Hospital (DH) in Nepal. Design: Retrospective data analysis focuses on data about NEC at Dhulikhel Hospital from the last two years. Since confirmation through abdominal X-ray has not been a standardized diagnostic tool, only suspected NEC cases are reported here. In this analysis cases were counted as suspected NEC when at least two of the following criteria were fulfilled: abdominal distension, feeding intolerance, occult blood in stool, melena, and Metronidazole treatment, whereby one of these two criteria had to be Metronidazole treatment. In the prospective study the intervention group receives a single strain probiotic (lactobacillus casei var. rhamnosus) solved in expressed breast milk (EBM) whereas the control group receives solely EBM. Evaluation of NEC incidence is planned after a 2-year period. Results: Retrospective analysis identified a total of 91 suspected NEC cases, including 52 % preterm, 46 % term neonates (7 % low birth weight (LBW), 7 % birth weight n.n.). Most neonates fulfilled three (58 %) or four (29 %) criteria accounted for suspected NEC. Mortality rate was high (36 %). Besides neonatal sepsis and respiratory distress the most common comorbidities included hyperbilirubinemia, birth asphyxia, dyselectrolytemia, neonatal meningitis and meconium aspiration. Within preterm neonates 42 % and within LBW neonates 43 % showed symptoms accounted for suspected NEC. Conclusion: Retrospective analysis confirmed that preterm and LBW neonates are at high risk to develop NEC. This work provides detailed information about newborns with suspected NEC in Nepal. Major limitations of this work are that suspected NEC cases were selected solely based on clinical symptoms and treatment, but an analysis of systemic signs or laboratory findings was not included and abdominal X-ray was not available.

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