Can We Cut the Incidence of Necrotizing Enterocolitis in Half — Today?

Abstract

Necrotizing enterocolitis (NEC) is a common gastrointestinal emergency of neonates. Population studies estimate the incidence of NEC at between 0.3 and 2.4 per 1000 live births in the United States, with a predominance of cases among preterm neonates born at the earliest gestational ages. The disease burden of NEC includes an overall disease-specific mortality rate of 15-20%, with yet higher rates in those of earliest gestations. The NEC burden also includes an increase in hospital costs approximating $100,000/case, as well as severe late sequellae including parenteral nutrition-associated liver disease and short bowel syndrome. Differentiating NEC from other forms of acquired neonatal intestinal disease is critical to assessing the success of NEC prevention strategies. Promising new prevention strategies are now being tested; one such is prophylactic heparin-binding epidermal growth factor-like growth factor (HB-EGF) administration. However, two prevention strategies have already been shown in meta-analyses to reduce the incidence of NEC, but we speculate that these are not being fully utilized. They are; 1) implementing a written set of feeding guidelines (also called standardized feeding regimens) for newborn intensive care unit (NICU) patients, and 2) implementing programs to increase the availability of human milk for patients at risk of developing NEC.

Fulminant necrotizing enterocolitis in a multihospital healthcare system

“…17,18 This also seems to be the case for the fulminant variety. Among 105 neonates in this study who developed NEC, the most significant associations with fulminant NEC were lower birth weight and lower gestational age.…”

Early gradual feeding with bovine colostrum improves gut function and NEC resistance relative to infant formula in preterm pigs

“…Despite this, current guidelines for early enteral feeding are usually not diet specific but focus on macronutrients and volume increments without differentiating among different types of milk (1,16,19). Given the uncertainty of existing guidelines, it remains to be elucidated whether optimizing the enteral feeding of formula could effectively reduce the incidence of NEC (13).…”

The Cost of Using Donor Human Milk in the NICU to Achieve Exclusively Human Milk Feeding Through 32 Weeks Postmenstrual Age

“…2,4 Consequently, an exclusive human milk (EHM) diet for preterm infants is promoted as one strategy in NEC prevention. 4,6,9 In the neonatal intensive care unit (NICU) environment, particularly with very preterm infants, it is not always possible for mothers to supply adequate volumes of expressed human milk. 10 There are also situations where it is not possible for mothers to provide any human milk at all, for example, in cases of maternal drug abuse or where there is a maternal choice not to express.…”