Necrotizing enterocolitis: It’s not all in the gut

Abstract

Necrotizing enterocolitis is the leading cause of death due to gastrointestinal disease in preterm neonates, affecting 5–12% of neonates born at a very-low birth weight. Necrotizing enterocolitis can present with a slow and insidious onset, with some neonates displaying early symptoms such as feeding intolerance. Treatment during the early stages includes bowel rest and careful use of antibiotics, but surgery is required if pneumoperitoneum and intestinal perforation occur. Mortality rates among neonates requiring surgery are estimated to be 20–30%, mandating the development of non-invasive and reliable biomarkers to predict necrotizing enterocolitis before the onset of clinical signs. Such biomarkers would allow at-risk neonates to receive maximal preventative therapies such as careful nutritional consideration, probiotics, and increased skin-to-skin care. Impact statement Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease; its high mortality rate mandates the development of non-invasive biomarkers to predict NEC before its onset. This review summarizes the pathogenesis, prevention, unresolved issues, and long-term outcomes of NEC.

Evaluation of Morbidities and Complications of Neonatal İntensive Care Unit Patients with Respiratory Disorders at Different Gestational Ages

“…The most important factor affecting this result may be the higher percentages of ELBW and VLBW infants in this study, compared to mentioned studies. 1,8,27 NEC is the leading cause of death due to gastrointestinal diseases in preterm neonates, affecting 5 to 12% of neonates born VLBW, 28 while more recent observational studies showed an incidence from 16.7 to 20.7%. 29 The incidence of NEC in newborns having acute respiratory disorders was 6.8% and higher than reported by Rubaltelli et al (1.7%) and Lenoir at al (2.4%).…”

Clinical Spectrum and Outcomes of Neonatal Necrotizing Enterocolitis

“…We also found that abdominal wall erythema was a relatively frequent symptom in our cohort, and had an adverse prognostic value. This phenomenon is rarely described in the literature, and it might be included in symptoms of abdominal distension (13).…”

Efficacy of Mesenchymal Stromal Cells in Preclinical Models of Necrotizing Enterocolitis: a Systematic Review Protocol

“…It was rst described by Mizrahi et al in 1965 (3). This disease is characterized by in ammation and injury to the wall barrier of the intestine that can cause necrosis and that can lead to bowel perforation (2,4,5). It is a major complication of preterm birth (6,7).…”

“…The pathogenesis of NEC is multifactorial (12). The most common known risk factors of NEC include low gestational age, low birth weight, exposure to infant formula-feeding and microbial dysbiosis (2,4,12,13). The classic NEC pathophysiological process of intestinal injury appears to be related to a basic immaturity of host defences, culminating in an excessive in ammatory response, with serum cytokines and chemokines, especially IL-8 signi cantly elevated (14)(15)(16) and imbalance of the healthy microbiome.…”

“…Survivors of a NEC episode are at increased risk of long-term adverse outcomes including gastrointestinal and neurodevelopmental complications (4). Because the disease occurs during an important time of brain development, the long-term NEC-associated neurodevelopment outcomes include cerebral palsy and visual, cognitive and psychomotor impairment (4,(17)(18)(19)(20)(21)(22). NEC also signi cantly increases hospital length of stay and health care costs.…”