Pathogenesis and prevention of necrotizing enterocolitis

Centre for Reviews and Dissemination, Hull York Medical School, University of York, Heslington, York, UK.
Current Opinion in Infectious Diseases (Impact Factor: 5.01). 03/2011; 24(3):183-9. DOI: 10.1097/QCO.0b013e328345d5b5
Source: PubMed


Necrotizing enterocolitis (NEC) remains the most common serious acquired gastrointestinal disorder affecting preterm infants. Here we review recent advances in our understanding of the pathogenesis of this multifactorial condition and consider the implications for practice and research.
NEC is an important cause of mortality and serious morbidity in preterm infants. The risk is inversely proportional to gestational age and weight at birth. Fetal growth restriction and compromise may be additional specific risk factors. NEC, particularly severe NEC requiring surgical intervention and NEC with invasive infection, is associated with acute morbidity and mortality and adverse neurodevelopmental outcomes. The principal modifiable postnatal risk factors for NEC in preterm infants relate to enteral feeding practices including formula milk feeding, early and rapid advancement of enteral feed volumes, and exposure to H2-receptor antagonists.
Our understanding of the pathogenesis of this condition remains incomplete. With the exception of feeding with human milk, only limited evidence is currently available to support interventions to prevent NEC. Promising strategies that merit further evaluation in randomized controlled trials include the use of prebiotics and probiotics and the avoidance of exposure to H2-receptor antagonists.

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    • "It is a syndrome of acute intestinal ischemic necrosis with premature birth as the primary risk factor[2]. A proposed etiology of the disease is that additional stresses are added to an immature gastrointestinal tract with a precarious vascular supply resulting in a cascade of events that lead to NEC[2]. The contribution of intestinal bacteria to the etiology of NEC is unclear. "
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