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HIV exposure does not worsen outcome in stage III necrotizing enterocolitis with current treatment protocols

dc.contributor.authorArnold M.
dc.contributor.authorMoore S.W.
dc.date.accessioned2012-05-17T08:58:56Z
dc.date.available2012-05-17T08:58:56Z
dc.date.issued2012
dc.identifier.citationJournal of Pediatric Surgery
dc.identifier.citation47
dc.identifier.citation4
dc.identifier.citation665
dc.identifier.citation672
dc.identifier.issn223468
dc.identifier.other10.1016/j.jpedsurg.2011.11.047
dc.identifier.urihttp://hdl.handle.net/10019.1/21030
dc.description.abstractBackground/Purpose: The heavy burden of maternal HIV infection in developing countries such as South Africa has resulted in a high prevalence of premature birth and necrotizing enterocolitis (NEC). Uninfected infants born to HIV-infected mothers also demonstrate immune deficiencies. It is, therefore, essential to have a better understanding of how to mitigate HIV as an independent risk factor for surgically treated NEC and to evaluate the relevant contributing factors in the presence of an aggressive strategy of pasteurized breast milk feeding and antiretroviral prophylaxis. Methods: Infants with stage IIIb NEC presenting over a 4-year period were retrospectively reviewed. HIV-exposed infants were compared with non-HIV-exposed infants. Contributing factors were evaluated and studied by systematic statistical methods to evaluate risk. Results: Twenty percent (17/87) infants were HIV-exposed, and 80% (70/87), unexposed, whereas a further 10 (total, n = 97) had unknown HIV exposure status. Demographics and other perinatal risk factors between the 2 groups were not significantly different other than that HIV-exposed infants received pasteurized breast milk and nonexposed infants received unpasteurized breast milk. There were no statistically significant differences between the groups with respect to disease presentation or severity, surgical findings or type of surgery, postoperative complications, survival, or timing of death. Trends toward higher antenatal steroid exposure and increased postoperative sepsis in the HIV-exposed group (P =.03) were noted but were not related. All HIV-exposed infants received antiretrovirals; there were no significant differences on subanalysis between different antiretroviral regimens. Conclusions: HIV-exposed infants do not have a more severe disease course nor more adverse outcomes in stage IIIb NEC than unexposed infants. Significant factors were antenatal steroids and post-NEC infective episodes. © 2012 Elsevier Inc.
dc.subjectnevirapine
dc.subjectsteroid
dc.subjectzidovudine
dc.subjectbreast milk
dc.subjectdisease course
dc.subjectdisease severity
dc.subjectfemale
dc.subjecthuman
dc.subjectHuman immunodeficiency virus infection
dc.subjectinfant
dc.subjectinfection risk
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmaternal disease
dc.subjectnecrotizing enterocolitis
dc.subjectpostoperative complication
dc.subjectprenatal exposure
dc.subjectpriority journal
dc.subjectreview
dc.subjectsepsis
dc.subjectsingle drug dose
dc.subjecttreatment outcome
dc.titleHIV exposure does not worsen outcome in stage III necrotizing enterocolitis with current treatment protocols
dc.typeReview


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