Necrotizing Enterocolitis

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In necrotizing enterocolitis (NEC) the small (most often distal) and/or large bowel becomes injured, develops intramural air, and may progress to frank necrosis with perforation. Even with early, aggressive treatment, the progression of necrosis, which is highly characteristic of NEC, can lead to sepsis and death. This article reviews the current scientific knowledge related to the etiology and pathogenesis of NEC and discusses some possible preventive measures.

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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