Necrotizing enterocolitis: current perspectives

Yajamanyam, Phani Kiran; Rasiah, SV; Ewer, Andrew

doi:10.2147/rrn.s36576

Cited by 14 publications

(18 citation statements)

References 132 publications

(139 reference statements)

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“…The increase of NEC was especially evident in extremely preterm infants and deaths during day 7-28 and after 28 days of life. This is likely due to NEC being a disorder typically occurring after 1-2 of weeks of life 30 and that the risk of NEC increases with decreasing gestational age at birth 31 . Another potential factor in the overall increase of NEC as a COD could be that improvements in clinical care over time enable the child to survive long enough to develop NEC as has been suggested previously 32 .…”

Section: Discussionmentioning

confidence: 99%

The Value of Autopsy in Preterm Infants At A Swedish Tertiary Neonatal Intensive Care Unit 2002-2018

Hoffsten

Márkász

Ericson

et al. 2021

Preprint

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Reliable data on causes of death (COD) in preterm infants is needed to assess perinatal care and current clinical guidelines. In this retrospective observational analysis of all deceased preterm infants born <37 weeks’ gestational age (n=278; 2012-2018) at a Swedish tertiary neonatal intensive care unit, we compared preliminary COD from Medical Death Certificates with autopsy defined COD (2002-2018), and assessed changes in COD between two periods (Period 1: 2002-2009 vs Period 2: 2011-2018). Autopsy was performed in 73% of all cases and was more than twice as high compared to national rates of infant autopsies in Sweden (33%). Autopsy defined COD differed from preliminary COD in 34.9% of the cases. Necrotizing enterocolitis (NEC) as COD increased between Period 1 and 2 (5% vs 26%), while intraventricular hemorrhage decreased (13% vs 6%). The autopsy rate did not change between the two study periods (75% vs 71%). We conclude that autopsy changed the preliminary COD in a third of cases, while the incidence of NEC as COD increased markedly during the study period. Since there is a high risk to determine COD incorrectly based solely on clinical findings in preterm infants, autopsy remains a valuable method to obtain reliable COD.

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Section: Discussionmentioning

confidence: 99%

The Value of Autopsy in Preterm Infants At A Swedish Tertiary Neonatal Intensive Care Unit 2002-2018

Hoffsten

Márkász

Ericson

et al. 2021

Preprint

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show abstract

“…There are, however, concerns that it may increase the risk of NEC. No statistically significant increase in NEC incidences were described in a Cochrane review for infants receiving fortified breast milk [17], and it is an established practice to fortify breast milk with cow's milk-based fortifiers in neonatal nutrition [12].…”

Section: The Debate Continues-what Milk Feed Is Best?mentioning

confidence: 99%

“…NEC is the most common neonatal gastrointestinal emergency, with 85% of cases being seen in those born either <32 weeks gestation or with a birth weight <1.5 kg. This is attributed to immature barrier function, poor digestion of feeds, and immature immune system of these infants [12]. The incidence of NEC varies depending on ethnicity; for example, it is higher in black male infants, where approximately 12% of infants born <1.5 kg are likely to develop NEC [13].…”

Section: Epidemiologymentioning

confidence: 99%

“…A recent trial involving 207 premature infants with a birth weight 500-1,250 g randomized to receive human or formula milk found markedly lower rates of NEC in the human milk group and the number needed to treat to prevent one case of NEC was 10 [16]. Short-and longterm benefits of being fed on breast milk are well known, e.g., improved feed tolerance and neurodevelopmental outcomes, reduced infection rates, hospital readmissions during childhood, and rates of developing NEC [12].…”

Section: The Debate Continues-what Milk Feed Is Best?mentioning

confidence: 99%

“…Given that maternal breast milk often does not meet the nutritional requirements of preterm babies, supplementing breast milk with fortifier to add extra carbohydrate, protein, calcium, and phosphorus improves weight gain and growth [12].…”

Section: The Debate Continues-what Milk Feed Is Best?mentioning

confidence: 99%

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Feeding growth restricted premature neonates: a challenging perspective

et al. 2018

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Nutrition in the postnatal period is essential to achieve optimal growth and maintain biochemical normality. Feeding growth-restricted premature neonates remains a big challenge for pediatricians and neonatologists. The choice of milk is one of the biggest challenges. Breast milk is recommended, although feeding with preterm formulas can ensure a more consistent delivery of optimal levels of nutrients. The timing of introduction of feeds and the rate of advancement of those feeds in preterm infants are both topics of significant controversy. Early feeding is advantageous because it improves the functional adaptation of the gastrointestinal tract and reduces the duration of total parenteral nutrition. A faster rate of advancement will also reduce the duration of need for parenteral nutrition. Despite this, enteral feeding is often delayed and is often slowly increased in high-risk infants because of a possible increased risk of necrotizing enterocolitis (NEC). Growth-restricted neonates are at increased risk of developing NEC due to a combination of antenatal and postnatal disturbances in gut perfusion. If enteral feeding is introduced earlier and advanced more quickly, this may lead to increased risk of NEC, but slower feeds extend the duration of parenteral nutrition and its risks and may have adverse consequences for survival, growth, and development. Premature infants pose a significant nutritional challenge. Overall, we would suggest the preferential use of human breast milk, early minimal enteral feeds, and standardized feeding protocols with cautious advancements of feeds to facilitate gastrointestinal adaptation and reduce the risk of NEC, however further research is needed.

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Paneth cell proteins DEFA6 and GUCA2A as tissue markers in necrotizing enterocolitis

et al. 2023

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Previous studies suggest that Paneth cells are involved in NEC development. Defensin alpha 6 (DEFA6) and guanylate cyclase activator 2A (GUCA2A) are selective protein markers of Paneth cells. The objective was to explore DEFA6 and GUCA2A expression in intestinal tissue samples from newborn infants with and without NEC. Tissue samples from histologically intact intestine were analyzed from 70 infants: 43 underwent bowel resection due to NEC and 27 controls were operated due to conditions such as intestinal atresia, dysmotility, aganglionosis, pseudo-obstruction or volvulus. Each tissue sample was immunohistochemically stained for DEFA6 and GUCA2A. Semi-automated digital image analysis was performed to determine protein expression. Clinical data and protein expressions were compared between the groups. DEFA6 expression was lower in the NEC group (p = 0.006). Low DEFA6 correlated with risk of developing NEC in a logistic regression analysis, independently of gestational age and birth weight (OR 0.843 [CI 0.732–0.971]; p = 0.018). GUCA2A expression did not differ between the two groups.Conclusion: Lower expression of DEFA6 together with intact GUCA2A expression indicates that NEC patients have well-defined Paneth cells but diminished defensin activity. Our results suggest that DEFA6 could be used as a biomarker for NEC. What is Known:• Previous studies of defensin activity in NEC have been inconsistent, showing that defensin levels may be increased or diminished in NEC. GUCA2A has to our knowledge never been studied in NEC. What is New:• This study benchmarks two specific Paneth cell markers (DEFA6 and GUCA2A) and their activity in individuals with and without NEC.• The key finding is that the NEC group had a lower DEFA6 expression compared to the Controls, while the expression of GUCA2A did not differ between the groups.

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Necrotizing enterocolitis: current perspectives

Cited by 14 publications

References 132 publications

The Value of Autopsy in Preterm Infants At A Swedish Tertiary Neonatal Intensive Care Unit 2002-2018

The Value of Autopsy in Preterm Infants At A Swedish Tertiary Neonatal Intensive Care Unit 2002-2018

Feeding growth restricted premature neonates: a challenging perspective

Paneth cell proteins DEFA6 and GUCA2A as tissue markers in necrotizing enterocolitis

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