Necrotizing Enterocolitis

Abstract

Neonatal necrotizing enterocolitis is the second most common cause of morbidity in premature infants and requires intensive care over an extended period. Despite advances in medical and surgical techniques, the mortality and long-term morbidity due to necrotizing enterocolitis remain very high. Recent advances have shifted the attention of researchers from the classic triad (ischemia, bacteria, and the introduction of a metabolic substrate into the intestine) of necrotizing enterocolitis, to gut maturation, feeding practices, and inflammation. The focus on inflammation includes proinflammatory cytokines such as tumor necrosis factor-alpha, interleukin (IL)-6, IL-18, and platelet-activating factor. Research related to the etiology of necrotizing enterocolitis has moved quickly from clostridial toxin to bacterial and other infectious agents. More recently, the pattern of bacterial colonization has been given emphasis rather than the particular species or strain of bacteria or their virulence. Gram-negative bacteria that form part of the normal flora are now speculated as important factors in triggering the injury process in a setting where there is a severe paucity of bacterial species and possible lack of protective Gram-positive organisms. Although the incidence of necrotizing enterocolitis has increased because of the survival of low birthweight infants, clinicians are more vigilant in their detection of the early gastrointestinal symptoms of necrotizing enterocolitis; however, radiographic demonstration of pneumatosis intestinalis remains the hallmark of necrotizing enterocolitis. With prompt diagnosis, a large proportion of infants with necrotizing enterocolitis are now able to be managed medically with intravenous fluid and nutrition, nasogastric suction, antibacterials, and close monitoring of physiologic parameters. In the advanced cases that require surgery, clinicians tend to opt for either simple peritoneal drainage (for very small and sick infants) or laparotomy and resection of the affected part. Intestinal transplantation later in life is available as a viable option for those who undergo resection of large segments of the intestine. It is becoming more evident that treatment of this devastating disease is expensive and comes with the toll of significant long-term sequelae. This has resulted in renewed interest in designing alternative strategies to prevent this serious gastrointestinal disease. Simple trophic feeding and the use of L-glutamine and arginine are novel avenues that have been examined. The use of probiotics ('friendly' bacterial flora) has been introduced as a promising tool for establishing healthy bacterial flora in the newborn gut to block the injury process that may ultimately lead to necrotizing enterocolitis.

The Infant Microbiome

“…La Rosa et al (2014) demonstrated, however, that the delay in commensal gut flora was recovered in the sampled population by 36 weeks postconceptional age, suggesting a short-term decrease and sequential rebound of microbial diversity. This rebound property has not been shown to mitigate the risk for infections such as necrotizing enterocolitis (NEC), however, which remains one of the leading causes of death in preterm infants (Panigrahi, 2006). In fact, NEC occurs most frequently during periods of decreased microbial diversity (Wang et al, 2009).…”

Necrotizing Enterocolitis and the Use of Thickened Liquids for Infants With Dysphagia

“…Necrotizing enterocolotis (NEC) is a condition seen almost exclusively in infants born prematurely and it is the second most common cause of morbidity in this population (Berman & Moss, 2011). Portions of the gut experience tissue death in NEC and treatment can vary from implementing bowel rest with frequent monitoring to surgical resection if there is bowel perforation (Panigrahi, 2006). While the exact cause of NEC is not yet established, there is a correlation between the age at which infants born prematurely begin enteral feedings and the type of enteral feed provided (Yee et al, 2012).…”

The Children of the Missed Pill

“…This represents a year-to-year growth of 24% in the weekly infant mortality of that kind. 40 In particular, we find a proportionally large effect on weekly infant deaths due to necrotizing enterocolitis of the newborn, a condition that typically develops among premature babies, especially those that are formula fed, and is the second most common cause of death among premature infants (Panigrahi, 2006). Our results indicate a year-to-year increase in weekly infant mortality due to necrotizing enterocolitis of about 73.25% among babies conceived after the price increase.…”