Neonatal necrotizing enterocolitis

Maheshwari, Akhil; Corbin, Laura L; Schelonka, Robert L.

doi:10.2147/rrn.s23459

Cited by 27 publications

(49 citation statements)

References 215 publications

(275 reference statements)

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“…1,2,12,33 This review will focus mainly on the potential risk factors associated with NEC and some of the current research relating to prevention and early diagnosis of NEC.…”

Section: Research and Reports Inmentioning

confidence: 99%

Necrotizing enterocolitis: current perspectives

Yajamanyam

Rasiah²,

Ewer³

2014

RRN

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Necrotizing enterocolitis is the most common gastrointestinal emergency in neonates, particularly in those born very preterm. It is a leading cause of morbidity and mortality, especially in extremely low birth weight infants. Despite extensive research, the pathophysiology of necrotizing enterocolitis remains unclear and therapeutic options are limited. Multiple risk factors have been reported, but most are associated with prematurity and its complications. This makes management very challenging in vulnerable preterm infants. In this review, we focus on the risk factors and some of the current research in this area, particularly studies aimed at early detection and potential preventive measures for this potentially lethal condition.

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“…1,2,12,33 This review will focus mainly on the potential risk factors associated with NEC and some of the current research relating to prevention and early diagnosis of NEC.…”

Section: Research and Reports Inmentioning

confidence: 99%

Necrotizing enterocolitis: current perspectives

Yajamanyam

Rasiah²,

Ewer³

2014

RRN

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“…amniotic fluid; NEC; HGF; inflammation; phosphoinositide 3-kinase NECROTIZING ENTEROCOLITIS (NEC), an inflammatory bowel necrosis of preterm infants, is a leading cause of death among neonates born before 32 wk of gestation or with a birth weight Ͻ1,500 g (20, 27). Although the etiology of NEC remains unclear, epidemiological studies show an association with diverse risk factors such as maternal chorioamnionitis, perinatal asphyxia, indomethacin therapy, viral infections, and blood transfusions (20). Current pathophysiological models suggest that NEC occurs when altered/disrupted epithelial barrier in the preterm intestine allows luminal bacteria to translocate across the epithelial barrier into the lamina propria, triggering a severe mucosal inflammatory response and tissue damage (21).…”

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confidence: 99%

“…NECROTIZING ENTEROCOLITIS (NEC), an inflammatory bowel necrosis of preterm infants, is a leading cause of death among neonates born before 32 wk of gestation or with a birth weight Ͻ1,500 g (20,27). Although the etiology of NEC remains unclear, epidemiological studies show an association with diverse risk factors such as maternal chorioamnionitis, perinatal asphyxia, indomethacin therapy, viral infections, and blood transfusions (20).…”

mentioning

confidence: 99%

“…Although the etiology of NEC remains unclear, epidemiological studies show an association with diverse risk factors such as maternal chorioamnionitis, perinatal asphyxia, indomethacin therapy, viral infections, and blood transfusions (20). Current pathophysiological models suggest that NEC occurs when altered/disrupted epithelial barrier in the preterm intestine allows luminal bacteria to translocate across the epithelial barrier into the lamina propria, triggering a severe mucosal inflammatory response and tissue damage (21).…”

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confidence: 99%

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Amniotic fluid-borne hepatocyte growth factor protects rat pups against experimental necrotizing enterocolitis

Jain

Baggerman

MohanKumar

et al. 2014

American Journal of Physiology-Gastrointestinal and Liver Physi

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fluid-borne hepatocyte growth factor protects rat pups against experimental necrotizing enterocolitis. Am J Physiol Gastrointest Liver Physiol 306: G361-G369, 2014. First published January 9, 2014; doi:10.1152/ajpgi.00272.2013.-Fetal swallowing of amniotic fluid, which contains numerous cytokines and growth factors, plays a key role in gut mucosal development. Preterm birth interrupts this exposure to amniotic fluid-borne growth factors, possibly contributing to the increased risk of necrotizing enterocolitis (NEC) in premature infants. We hypothesized that supplementation of formula feeds with amniotic fluid can provide amniotic fluid-borne growth factors and prevent experimental NEC in rat pups. We compared NEC-like injury in rat pups fed with infant formula vs. formula supplemented either with 30% amniotic fluid or recombinant hepatocyte growth factor (HGF). Cytokines/growth factors in amniotic fluid were measured by immunoassays. Amniotic fluid and HGF effects on enterocyte migration, proliferation, and survival were measured in cultured IEC6 intestinal epithelial cells. Finally, we used an antibody array to investigate receptor tyrosine kinase (RTK) activation and immunoblots to measure phosphoinositide 3-kinase (PI3K) signaling. Amniotic fluid supplementation in oral feeds protected rat pups against NEC-like injury. HGF was the most abundant growth factor in rat amniotic fluid in our panel of analytes. Amniotic fluid increased cell migration, proliferation, and cell survival in vitro. These effects were reproduced by HGF and blocked by anti-HGF antibody or a PI3K inhibitor. HGF transactivated several RTKs in IEC6 cells, indicating that its effects extended to multiple signaling pathways. Finally, similar to amniotic fluid, recombinant HGF also reduced the frequency and severity of NEC-like injury in rat pups. Amniotic fluid supplementation protects rat pups against experimental NEC, which is mediated, at least in part, by HGF. amniotic fluid; NEC; HGF; inflammation; phosphoinositide 3-kinase NECROTIZING ENTEROCOLITIS (NEC), an inflammatory bowel necrosis of preterm infants, is a leading cause of death among neonates born before 32 wk of gestation or with a birth weight Ͻ1,500 g (20, 27). Although the etiology of NEC remains unclear, epidemiological studies show an association with diverse risk factors such as maternal chorioamnionitis, perinatal asphyxia, indomethacin therapy, viral infections, and blood transfusions (20). Current pathophysiological models suggest that NEC occurs when altered/disrupted epithelial barrier in the preterm intestine allows luminal bacteria to translocate across the epithelial barrier into the lamina propria, triggering a severe mucosal inflammatory response and tissue damage (21).During intrauterine development, the fetus ingests progressively large volumes of amniotic fluid, which contains several cytokines and growth factors known to promote gut mucosal development (19). In the third trimester, the human fetus swallows nearly 550 ml/day amniotic fluid (29, 40). We hypothesiz...

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“…We recognize that our NEC rate of 15.1% prior to L. reuteri prophylaxis was higher than the rates recorded in other reports, and a more realistic number in other NICUs might be around 10%. 20 This would reduce the economic impact. We are unable to explain our relatively high NEC rate, since no obvious predisposing factors stood out.…”

Section: Discussionmentioning

confidence: 99%

Pharmacoeconomic impact of use of the probiotic Lactobacillus reuteri DSM 17938 for prevention of necrotizing enterocolitis in extremely low-birth-weight infants

Dimaguila¹,

Gál²,

Wilson³

et al. 2013

RRN

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Background:A recent study showed that use of Lactobacillus reuteri as probiotic prophylaxis decreased the necrotizing enterocolitis (NEC) rate from 15.1% to 2.5% in neonates with birth weight below 1000 g. Given the controversies surrounding use of probiotics in neonatal intensive care units, we address one additional aspect of routine implementation of probiotics for NEC prophylaxis -the pharmacoeconomic impact. Methods: Using data from our initial published experience, and continuing data collection after instituting a higher dose of L. reuteri, we measured the reduction in NEC in neonates with birth weight below 1000 g. Cost savings from prior studies examining the cost and outcomes of medical and surgical NEC were used to calculate the financial impact of routine L. reuteri DSM 17938 prophylaxis. Results: Medical records for 354 neonates were reviewed, 232 in the years before introduction of L. reuteri prophylaxis and 79 who received L. reuteri prophylaxis dosed at 0.1 mL daily and 43 neonates given a total daily dose of 0.2 mL as one or two doses. The incidence of NEC was significantly lower in the neonates who received L. reuteri (two of 122 neonates [1.6%] versus 35 of 232 neonates [15.1%]). The expected benefits for our neonatal intensive care unit per 100 extremely low-birth-weight neonates treated were four fewer deaths, five fewer cases of medical NEC, eight fewer cases of surgical NEC, one less patient with short-bowel syndrome, and a cost saving of approximately $2.2 million. Conclusion: Prophylactic initiation of L. reuteri as a probiotic for prevention of NEC in neonates with birth weight # 1000 g is a cost-effective strategy during their stay in neonatal intensive care.

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Neonatal necrotizing enterocolitis

Cited by 27 publications

References 215 publications

Necrotizing enterocolitis: current perspectives

Necrotizing enterocolitis: current perspectives

Amniotic fluid-borne hepatocyte growth factor protects rat pups against experimental necrotizing enterocolitis

Pharmacoeconomic impact of use of the probiotic Lactobacillus reuteri DSM 17938 for prevention of necrotizing enterocolitis in extremely low-birth-weight infants

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