Current Knowledge of Necrotizing Enterocolitis in Preterm Infants and the Impact of Different Types of Enteral Nutrition Products

Abstract

Preterm infants are extremely vulnerable to a range of morbidities and mortality. Underdeveloped cardiac, respiratory, gastrointestinal, and immune systems in the preterm period increase the risk of necrotizing enterocolitis (NEC), a serious disease of the gut. NEC affects 5-12% of very-low birthweight infants, leads to surgery in 20-40% of cases, and is fatal in 25-50% of cases. There are multiple factors that may contribute to NEC, but the exact cause is not yet fully understood. Severe cases can result in intestinal resection or death, and the health care costs average >$300,000/infant when surgical management is required. Different types of nutrition may affect the onset or progression of NEC. Several studies have indicated that bovine milk-based infant formulas lead to a higher incidence of NEC in preterm infants than does human milk (HM). However, it is not clear why HM is linked to a lower incidence of NEC or why some infants fed an exclusively HM diet still develop NEC. An area that has not been thoroughly explored is the use of semielemental or elemental formulas. These specialty formulas are easy to digest and absorb in the gut and may be an effective nutritional intervention for reducing the risk of NEC. This review summarizes what is known about the factors that contribute to the onset and progression of NEC, discusses its health care cost implications, and explores the impact that different formulas and HM have on this disease. Adv Nutr 2017;8:80-91.

Necrotizing enterocolitis attenuates developmental heart rate variability increases in newborn rats

“…In the United States, ~10% of neonates are born at a gestational age less than 37 weeks, of these neonates, those born at a very‐low birth weight (VLBW; <1500 g) are at an increased risk of morbidities, including necrotizing enterocolitis (NEC). Approximately 5%‐12% of VLBW neonates develop NEC, with a higher incidence in more crowded and stressful neonatal intensive care units (NICU), and approximately 30% of these patients will not survive …”

“…Approximately 5%-12% of VLBW neonates develop NEC, with a higher incidence in more crowded and stressful neonatal intensive care units (NICU), and approximately 30% of these patients will not survive. [2][3][4][5][6] In rodent models, histological NEC is characterized by damage to the intestinal wall ranging from mild mucosal injury in the early phases of the disease (grade 1-2), to pneumatosis intestinalis, submucosal hemorrhage, and perforation as the disease progresses to fulminant NEC with intestinal necrosis (grade [3][4]. 7 In humans, risk factors for NEC include preterm birth, VLBW, formula feeding, mechanical ventilation, and infections such as chorioamnionitis.…”

Microbiota supplementation withBifidobacteriumandLactobacillusmodifies the preterm infant gut microbiota and metabolome

“…Compared to full-term infants preterm infants are more often born via Caesarean-section, have an underdeveloped immune system, receive numerous courses of antibiotics, and reside in neonatal intensive care units (NICUs); all of which disrupt the establishment of the early life gut microbiota (Gasparrini et al, 2019;Mulder et al, 2011;Walker, 2017). This altered gut microbial ecosystem has been linked to an increased risk of serious morbidity during the NICU stay, including necrotizing enterocolitis (NEC) (Shulhan et al, 2017) and late onset sepsis (LOS) (Pammi and Weisman, 2015), and later life health problems such as asthma and eczema (Been et al, 2014;Haataja et al, 2016).…”

Ghrelin ameliorates the phenotype of newborn rats induced with mild necrotizing enterocolitis

“…Necrotizing enterocolitis (NEC) is a devastating gastrointestinal (GI) disease that occurs in 5%‐12% of very low birthweight (<1500 g) neonates, and approximately 30% of these patients do not survive . The clinical presentation of NEC can be slow and insidious at first with symptoms such as feeding intolerance, but can drastically progress to fulminant NEC with hallmark signs such as pneumatosis intestinalis .…”

“…Necrotizing enterocolitis (NEC) is a devastating gastrointestinal (GI) disease that occurs in 5%-12% of very low birthweight (<1500 g) neonates, and approximately 30% of these patients do not survive. [1][2][3][4][5] The clinical presentation of NEC can be slow and insidious at first with symptoms such as feeding intolerance, but can drastically progress to fulminant NEC with hallmark signs such as pneumatosis intestinalis. 2,[5][6][7][8][9][10][11][12][13] This drastic onset of symptoms highlights the need for non-invasive biomarkers to identify neonates at risk for NEC and to develop new treatment modalities to prevent NEC progression.…”