Necrotizing Enterocolitis
Section snippets
Epidemiology and risk factors
NEC is a disease familiar to all practitioners who care for very low birth weight (VLBW) babies. It also can be considered a disease of medical progress, because the routine use of antenatal steroids and prophylactic surfactant has resulted in higher survival of preterm infants, and it is this group that is most susceptible to this potentially devastating disease [2]. There is a well-known inverse relationship between the incidence of NEC and gestational age at birth, with extremely premature
Etiology and pathogenesis
Although extensive research has investigated the pathophysiology of NEC, a complete understanding has not been elucidated fully. The most accepted epidemiologic precursors for NEC are prematurity [3], [39] and gastrointestinal feeding [39].
Santulli and colleagues [40] described the classic triad of pathologic events in the pathogenesis of NEC: (1) intestinal ischemia (2) colonization by pathogenic bacteria, and (3) excess protein substrate in the intestinal lumen. Subsequently Kosloske [41]
Prevention
Because the onset of NEC often is abrupt and overwhelming, with rapid progression, it seems unlikely that intervention strategies to halt the progression will succeed after the presentation of clinical signs and symptoms. In contrast, preventive approaches have had some success, and clinical trials have reported reduction of disease with the use of breast-milk feeding [34], [116], [117], [131], [132], enteral antibiotic prophylaxis [133], probiotics [134], [136], and arginine supplements [137].
Summary
The incidence of neonatal NEC and the mortality stemming from this disease have not improved significantly during the last 40 years. Still, many animal and human studies have emerged to help clinicians unfold numerous pathophysiologic abnormalities at the cellular level. A better understanding of this basic information may improve significantly the outcomes of patients who have this potentially devastating disease. One of the more promising of the various strategies proposed for the prevention
Acknowledgments
The authors thank Rita Maier, Director, Health Education Library, New York Hospital Queens, and her staff for their timely help in providing the necessary resources related to literature search.
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Racial disparities in the development of comorbid conditions after preterm birth: A narrative review
2022, Seminars in PerinatologyCitation Excerpt :Building on this work, Guthrie et al. used an administrative database for births across 24 states between 1998-2000 among neonates between 23-34 weeks GA, and found that Black infants developed NEC more often than other infants.90 Several studies followed with similar findings that non-Hispanic Black infants were more likely to develop NEC and experienced higher rates of NEC-associated mortality, compared to infants of other races even after adjusting for birthweight and other clinical and demographic characteristics.91–93 When stratifying by GA, Anderson et al. found that Black infants born between 32-34 weeks (OR 1.49; 95%CI 1.03, 2.16) and 34-36 weeks (OR 2.29 95%CI 1.14, 4.58) were more likely to develop NEC than non-Black infants, however no difference was found in the <32 week GA stratification groups, suggesting that differential care practices for older infants may modulate the inherent risk based on immaturity.11
The Neonate
2016, Obstetrics: Normal and Problem PregnanciesInterleukin-8 predicts 60-day mortality in premature infants with necrotizing enterocolitis
2014, Journal of Pediatric SurgeryDual purpose use of preterm piglets as a model of pediatric GI disease
2014, Veterinary Immunology and ImmunopathologyCitation Excerpt :Necrotizing enterocolitis (NEC) is a devastating and potentially lethal gastrointestinal disease in preterm (<37 weeks gestation) neonates. The disease is the most common gastrointestinal complication with an incidence of 3–10% in preterm neonates (Srinivasan et al., 2008). Despite extensive gain of knowledge regarding its pathogenesis, the incidence of NEC and its associated morbidity and mortality remain a significant health challenge (Horbar et al., 2002).
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