Necrotizing enterocolitis

Abstract

Necrotizing enterocolitis (NEC) is an acute inflammatory disease of the intestine which primarily affects preterm infants and is a leading cause of morbidity and mortality in the neonatal intensive care unit. From a clinical standpoint, and during the early course of the disease, NEC can be difficult to distinguish from other diseases and conditions common to the preterm infant, and this warrants the need for specific disease biomarkers. The pathogenesis of NEC is only partly understood but likely involves an altered intestinal barrier immune response to feeding and the developing microbiome. Recent evidence points toward a role of the enteric nervous system in NEC pathogenesis. In this issue, Meister and colleagues use a rodent model of NEC to demonstrate that NEC is associated with diminished vagal tone, as determined by decreased high‐frequency heart rate variability (HF‐HRV), and altered myenteric nitrergic inhibitory neurotransmission. These results augment their previous findings that describe decreased HF‐HRV in human preterm infants with NEC. This mini‐review provides a brief summary of clinical and pathophysiologic aspects of NEC with focus on certain aspects of neurogastroenterology.

Post-necrotizing enterocolitis stricture: a complication that the diagnosis can be missed with a high mortality in infants

“…A missed diagnosis of a post-NEC intestinal stricture causes mortality and life-threatening morbidity due to sepsis or perforation of the intestinal wall (2, 3, 6). The incidence of strictures was reported to be between 14% and 48% after an episode of NEC (1)(2)(3)8). The critical period when stricture development may occur is the in the first 3 months following the remission of the initial acute episode (1,2,8).…”

“…The incidence of strictures was reported to be between 14% and 48% after an episode of NEC (1)(2)(3)8). The critical period when stricture development may occur is the in the first 3 months following the remission of the initial acute episode (1,2,8). To avoid delays in the diagnosis and treatment, the staff of the neonatal intensive care unit, pediatricians, pediatric gastroenterologists, and pediatric surgeons should be well-informed about the symptoms of post-NEC strictures (1)(2)(3)(4)(5)8).…”

“…The critical period when stricture development may occur is the in the first 3 months following the remission of the initial acute episode (1,2,8). To avoid delays in the diagnosis and treatment, the staff of the neonatal intensive care unit, pediatricians, pediatric gastroenterologists, and pediatric surgeons should be well-informed about the symptoms of post-NEC strictures (1)(2)(3)(4)(5)8). These symptoms are often misdiagnosed as recurrent functional constipation, enteritis, and nutritional disorders.…”

“…Necrotizing enterocolitis (NEC) is a serious disorder manifesting with partial or complete ischemia of the intestines. The mortality ranges from 30% to 40% (1). In patients suffering from an acute NEC episode, a degree of obstruction secondary to ischemic intestinal damage develops at rates of up to 40% during the recovery period (2)(3)(4).…”

Mesenchymal stem cell-derived secretomes for therapeutic potential of premature infant diseases

“…NEC is the most common neonatal gastrointestinal emergency, mainly occurring in premature newborns with birth weights less than 1500 g [100]. NEC is treated with surgery and conservative and symptomatic treatment, including fasting with total parenteral nutrition, gastrointestinal decompression and drainage, and fluid balance.…”