Necrotizing Enterocolitis: A Narrative Review of Updated Therapeutic and Preventive Interventions

Abstract

Context: Necrotizing enterocolitis (NEC) remains one of the most common causes of morbidity and mortality for premature infants in the neonatal intensive care unit (NICU). Many theories concerning its pathophysiology and inciting factors have been suggested but progression in preventing the onset of NEC has been minimal. While this article highlights the pathophysiology, management, and outcomes of NEC, it mainly serves as a narrative review to discuss the emerging methods of treatment and prevention.Evidence Acquisition: A literature search was done using Medline/Pub Med, Cochrane Database of Systematic Reviews via Ovid, and CINAHL Complete with focus on articles published between 2000 and 2016. Searched terms included the following: necrotizing enterocolitis, pathogenesis, prevention, management, breast milk, formula, probiotics, prebiotics, and treatment. Results:Intestinal barrier dysfunction, hypoxic ischemic injury, receipt of packed red blood cells, immature intestinal immunity and alterations of the gut microbiome of the premature infant were reviewed factors that have been studied related to the pathophysiology of NEC. The presentation, staging and management remain relatively unchanged in the last few decades, though there have been a few studies evaluating different surgical options, various antibacterial regimen, and recently use of moderate hypothermia and amniotic fluid stem cells to treat NEC. Use of breast milk, use of pre-, pro-and postbiotics show promise in the prevention of NEC.Conclusions: NEC is a likely multifactorial illness of the gastrointestinal tract affecting mostly premature infants. Recent studies have focused on preventative strategies, with promise in pre-, pro-and postbiotics; however continued research is imperative.

Postbiotics for Preventing and Treating Common Infectious Diseases in Children: A Systematic Review

“…Since early 1980, the use of probiotics has been proposed to reduce the burden of common infectious disease among children [2][3][4][5] and infants [6]. However, a noteworthy part of the scientific community does not support probiotic interventions in younger children, due to rare case reports of probiotic-related infections such as bacteremia, necrotizing enterocolitis, pneumonia, and meningitis [7][8][9][10][11]. In addition, it has been stated that specific probiotic strains could express putative virulence factors, thus, increasing their tendency to adhere, invade, and produce cytotoxic effects [12].…”

Is thrombocytopenia and postnatal weight gain associated with treatment‐requiring retinopathy of prematurity? A matched case–control study

“…PLT not only appeared to be lower almost over all time points in cases compared with controls but only reached statistical significance in the PMA week with the highest number of subjects tested and also at the very beginning of life (1 st and 2 nd PNA week for PLT and 1 st PNA week for PMI). Previous reports assessing the association of PLT or MPV or PMI in the first week of PNA with severe ROP were all cohort studies that did not adjust for GA, BW, NEC or sepsis (Cekmez et al, 2013;Okur et al, 2016;Ozturk et al, 2021;Parrozzani et al, 2021;Şahinoğlu KeŞkek et al, 2020). In a retrospective case-control study, (Korkmaz et al, 2018) no differences in median PLT during ROP phase 1 (first 10 days of life) or ROP phase 2 (PMA ≥ 32 weeks for infants with GA < 27 weeks, PMA ≥ 33 weeks for infants with GA 27-29 weeks, PMA ≥ 34 weeks for infants with GA > 30 weeks) were found between cases and controls, while higher median PMI was ascertained in cases compared with controls during ROP phase 2, as opposed to our study.…”

“…The extracted data included demographic characteristics (gender, date of birth, GA, BW), maximum ROP stage (in either eye) and most central ROP zone, date of first treatment, daily weight, all available PLT and MPV values, PT (date and volume of transfusion) and comorbidities associated with both thrombocytopenia and TR‐ROP, that is necrotizing enterocolitis (NEC) and sepsis, as potential confounders (Kim et al, 2018; Roberts et al, 2008). NEC was defined as Bell's stage ≥II (Bell et al, 1978; Reid & Thompson‐Branch, 2016). Sepsis was defined as one positive blood culture with a clinical picture suggestive of systemic infection.…”

Influences of Feeding on Necrotizing Enterocolitis

“…Impaired gut motility leads to bacterial stasis, with subsequent bacterial translocation across a leaky, inflamed, and ischemic intestinal epithelium contributing to the pathogenesis of the disorder. (10) (15) The most commonly described risk factors for NEC are extreme prematurity and enteral feeding. Numerous studies have pointed to the receipt of breast milk as a protective factor in decreasing the risk of NEC.…”