An update on necrotizing enterocolitis: pathogenesis and preventive strategies

Abstract

Necrotizing enterocolitis (NEC) is one of the most critical morbidities in preterm infants. The incidence of NEC is 7% in very-low-birth-weight infants, and its mortality is 15 to 30%. Infants who survive NEC have various complications, such as nosocomial infection, malnutrition, growth failure, bronchopulmonary dysplasia, retinopathy of prematurity, and neurodevelopmental delays. The most important etiology in the pathogenesis of NEC is structural and immunological intestinal immaturity. In preterm infants with immature gastrointestinal tracts, development of NEC may be associated with a variety of factors, such as colonization with pathogenic bacteria, secondary ischemia, genetic polymorphisms conferring NEC susceptibility, anemia with red blood cell transfusion, and sensitization to cow milk proteins. To date, a variety of preventive strategies has been accepted or attempted in clinical practice with regard to the pathogenesis of NEC. These strategies include the use of breast feeding, various feeding strategies, probiotics, prebiotics, glutamine and arginine, and lactoferrin. There is substantial evidence for the efficacy of breast feeding and the use of probiotics in infants with birth weights above 1,000 g, and these strategies are commonly used in clinical practice. Other preventive strategies, however, require further research to establish their effect on NEC.

Early mortality after neonatal surgery: analysis of risk factors in an optimized health care system for the surgical newborn

“…Thirtyday post-operative mortality was 19 times greater among children with ASA scores 3 or above. Regarding necrotizing enterocolitis, which is known to be a life-threatening condition mainly related to immaturity and low birth weight [21][22][23] , our results were largely consistent with others that report post-operative high morbidity and mortality following surgery for this condition, given its progression to abdominal sepsis with multiorgan failure [24][25][26] . In the current study, necrotizing enterocolitis was found to be the leading primary cause of in-hospital mortality following neonatal surgery, accounting for 41% of all causes of 30-day post-operative mortality.…”

ADHD and Present Hedonism: time perspective as a potential diagnostic and therapeutic tool

“…In a prospective study, higher rates of alcohol consumption were found among Present Hedonistic and Past Negative individuals 34. Impulsive drinking and drug abuse were directly correlated with ADHD diagnosis in various studies 35,36. Individuals with a diagnosis of childhood ADHD and conduct disorder were found to be at much higher risk than controls for becoming “drug abusers” in adolescence 37…”

Cord blood epidermal growth factor as a possible predictor of necrotizing enterocolitis in very low birth weight infants

“…Indeed, the protective role of maternal milk in NEC pathogenesis has been reported both in human [9] and animal studies [14,27]. These findings stimulated the search for various components of milk that might be responsible for protection against NEC.…”

“…Several potential preventive strategies have aimed at induction of gastrointestinal maturation in premature infants, however, none of them have led to consistently positive results [6][7][8][9].…”