Necrotizing Enterocolitis Risk State of the Science

College of Nursing, University of Arizona, Tucson, 85721, USA.
Advances in Neonatal Care (Impact Factor: 1.12). 04/2012; 12(2):77-87; quiz 88-9. DOI: 10.1097/ANC.0b013e31824cee94
Source: PubMed


Necrotizing enterocolitis (NEC) is the most common cause of gastrointestinal-related morbidity and mortality in the neonatal intensive care unit (NICU). Its onset is sudden and the smallest, most premature infants are the most vulnerable. Necrotizing enterocolitis is a costly disease, accounting for nearly 20% of NICU costs annually. Necrotizing enterocolitis survivors requiring surgery often stay in the NICU more than 90 days and are among those most likely to stay more than 6 months. Significant variations exist in the incidence across regions and units. Although the only consistent independent predictors for NEC remain prematurity and formula feeding, others exist that could increase risk when combined. Awareness of NEC risk factors and adopting practices to reduce NEC risk, including human milk feeding, the use of feeding guidelines, and probiotics, have been shown to reduce the incidence of NEC. The purpose of this review is to examine the state of the science on NEC risk factors and make recommendations for practice and research.

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Available from: Sheila M Gephart
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    • "Necrotizing enterocolitis (NEC) causes significant morbidity and mortality in the neonatal intensive care unit[1]. It is a syndrome of acute intestinal ischemic necrosis with premature birth as the primary risk factor[2]. "
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    ABSTRACT: Necrotizing enterocolitis (NEC) leads to significant morbidity and mortality in the neonatal intensive care unit. Although current evidence would suggest that bacteria contribute to the pathogenesis of NEC, no single bacterium has yet been identified. The aims of this study were to investigate fecal S100A12 concentrations and the intestinal bacterial community in premature infants (24-32 weeks) and investigate any associations between the microbiota and the development of NEC. Meconium and feces were collected from premature newborn infants (between 24 and 32 weeks gestation) over the first 4 weeks of life. Fecal S100A12 concentrations were assayed by immunoassay, and samples were subject to 16S rDNA analysis using next-generation sequencing techniques. Fecal samples were collected from four infants that developed NEC and 18 control infants. Prior to developing NEC, fecal S100A12 concentrations were not elevated; however, following NEC diagnosis, concentrations were highly elevated. The fecal bacterial communities of infants with NEC did not differ significantly from control infants. However, potentially pathogenic bacteria were detected in significantly more infants with NEC than in controls (p = 0.0007). At birth, fecal S100A12 concentrations were not elevated in premature infants subsequently developing NEC in this cohort. Following NEC diagnosis, S100A12 concentrations were highly elevated, suggesting that this potentially could act as a marker of disease progression. Higher detection rates of potentially pathogenic bacteria in NEC infants suggest that a range of potentially pathogenic bacteria may collectively contribute to NEC pathogenesis.
    Preview · Article · Aug 2015 · Digestive Diseases and Sciences
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    ABSTRACT: Necrotizing enterocolitis (NEC) is a leading cause of prolonged hospitalizations for premature infants in the United States. In a recent large retrospective study, a significant proportion of NEC cases were shown to occur within 48 hours of packed red blood cell (PRBC) transfusion, especially in growing preterm neonates of older postnatal age. A small body of evidence consistently demonstrates that 25-35 percent of NEC cases are temporally associated with PRBC transfusion and that cases of NEC associated with transfusion are generally more severe with a higher rate of surgical intervention and mortality. Awareness of this association is vital for potential prevention and early recognition of NEC. The neonatal nurse has a primary role in care strategies that may affect NEC. This review of literature was compiled to educate neonatal nurses about the existence of transfusion-associated necrotizing enterocolitis and guide the translation of knowledge into nursing practice at the bedside.
    No preview · Article · May 2013 · Neonatal network: NN

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