Necrotizing Enterocolitis – 150 Years of Fruitless Search for the Cause

Abstract

Necrotizing enterocolitis (NEC) is not a new disease but one that has been reported since special care units began to house preterm infants. It was observed in foundling hospitals in Paris [Billard, 1828] and Vienna [Bednar, 1850] and, as it occurred in clusters, was regarded as a nosocomial infection in the infant hospitals of Zurich [Willi, 1944] and Berlin [Ylppö, 1931]. Clinical and patho-anatomic characterization was achieved by Schmidt and Quaiser in 1952. The unproven hypothesis of mesenteric hypoperfusion as a major etiological factor arose from animal models and analogous perforating disorders in term infants. Despite similarities between NEC and clostridial infections, few studies employed anaerobic culture techniques. The pathogenesis remains unclear and its distinction from related disorders uncertain. It is unlikely that strategies to prevent NEC will be successful unless the disease is better understood.

Chorioamnionitis and neonatal morbidity: current perspectives

“…Although believed to be multifactorial, the exact mechanism of its development is not fully understood, and its incidence has not changed substantially over time. 75 It affects around 7% of neonates with BW 500-1,500 g, and 11.5% in the subgroup of ≤750 g. 76 Mortality varies between 20% and 30%, and it is higher in patients requiring surgery. 77,78 Evidence relating CA to NEC is not consistent, but several studies, summarized in the meta-analysis of Been et al, 79 support that CCA is significantly associated with NEC (odds ratio [OR] 1.24, 95% CI 1.01-1.52; P=0.04), as well as HCA with fetal involvement (OR, 3.29; 95% CI, 1.87-5.78; P≤0.001).…”

Necrotizing enterocolitis: current perspectives

“…1,2,12,33 This review will focus mainly on the potential risk factors associated with NEC and some of the current research relating to prevention and early diagnosis of NEC.…”

“…NEC remains a challenging condition for neonatologists worldwide, with unclear pathogenesis, treatment options that might prove inadequate, a mortality rate as high as 50%, 1 and high morbidity among survivors of significant disease, including short gut syndrome and significantly increased hospitalization. 1 Even though it was first described more than a century ago, 2 and although significant recent advances have been achieved in other complications of prematurity, such as respiratory distress syndrome, NEC remains a major cause of death. The main difficulties are predicting which babies will develop the disease and establishing the diagnosis before fulminant disease has occurred.…”

Usefulness of Probiotics for Neonates?

“…Besides, necrotizing enterocolitis (NEC) remains an important cause of morbidity and mortality among very preterm infants. Despite many investigations, its pathogenesis remains unclear [135]. The hypothesis that intestinal microbes are necessary for the development of NEC is supported by several lines of evidence [136].…”