New Therapies and Preventive Approaches for Necrotizing Enterocolitis: Report of a Research Planning Workshop

Grave, Gilman D.; Nelson, Stefanie A.; Walker, W. Allan; Moss, Richard L.; Dvořák, Bohuslav; Hamilton, Frank A.; Higgins, Rosemary D.; Raju, Tonse N.K.

doi:10.1203/pdr.0b013e318142580a

Cited by 162 publications

(138 citation statements)

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“…This association is one of many links between feeding and NEC pathogenesis. [2][3][4] Other differences are apparent between patients who develop early NEC vs classical NEC. For instance, Guthrie et al 16 examined patients with classical NEC vs controls who did not develop NEC, and found them to be more likely to be delivered vaginally, with lower 5-min Apgar scores, and with lower birth weights.…”

Section: Discussionmentioning

confidence: 99%

“…4 This illness might also be refractory to prevention using human milk. Thus, we maintain that as NEC prevention schemes are tested, 3 it will be useful to attempt to categorize the NEC cases into component entities. The present data and that in our previous report 9 lead us to conclude that term and early NECs are pathogenically similar.…”

Section: Discussionmentioning

confidence: 99%

“…2 However, in part, this failure is due to the lack of successful NEC prevention strategies. 3 Perhaps one reason prevention strategies have not been particularly successful is that NEC is a multifactorial disease. Consequently, no single approach to prevention is likely to pertain to all subtypes.…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, no single approach to prevention is likely to pertain to all subtypes. 3,4 To focus our efforts on a small and potentially more homogeneous subtype of NEC, we conducted the present study of NEC occurring in the week following delivery. Using the data sets of Intermountain Healthcare, a healthcare delivery system in the western United States, we identified all patients in the past 6 years with Bell stage XII NEC diagnosed during the first week.…”

Section: Introductionmentioning

confidence: 99%

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Necrotizing enterocolitis during the first week of life: a multicentered case–control and cohort comparison study

et al. 2008

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Objective: Necrotizing enterocolitis (NEC) is rare during the first week of life; most cases occur after 2 to 4 weeks. We hypothesized that when NEC develops in the first week, certain predisposing factors and feeding practices are identifiable. To test this, we sought to identify every case of NEC diagnosed during the first week within the Intermountain Healthcare system during the most recent 6-year period.Study Design: Data were collected from neonates admitted to any Intermountain Healthcare neonatal intensive care unit (NICU) with a date of birth from 1 January 2001 through 31 December 2006. Electronic and paper records were obtained for all with a diagnosis of NEC (Bell stage XII) within the first 168 h. X-rays, physician notes, nursing records, laboratory reports and operative reports were subjected to critical review to reexamine the diagnosis of NEC. Among those with confirmed NEC, we recorded underlying conditions and every feeding given prior to the diagnosis of NEC. Comparisons were made with patients that did not develop NEC, yet were cared for in the same NICUs, during the same period of time, and of the same gestational ages.Result: A total of 28 neonates were identified electronically as having NEC during the first week. Critical review confirmed this in 21, but 5 were determined at laparotomy to have had spontaneous intestinal perforation, and 2 others were found on surgical reports to have had a congenital infarction of the colon. Total 20 of the 21 confirmed cases developed NEC while in a NICU being treated for another condition. The exception was a small-for-gestational-age neonate in a well baby nursery. Compared to 6100 controls, the 21 with early NEC were more likely to have had a meconium-positive test for illicit drug exposure (P<0.005), early onset sepsis (P<0.034) and respiratory distress (P<0.039). They were less likely than case-controls to have been fed human milk (P ¼ 0.003) and were more likely to have been fed formula exclusively (P ¼ 0.019).None who were fed human milk exclusively developed early NEC. Twelve of the twenty-one were fed (by gavage or bottle) amounts exceeding the upper limit of volumes taken by breastfed neonates. Conclusion:We speculate that the prevalence of NEC during the first week could be reduced by identifying at-risk patients, feeding them human milk exclusively for the first week and using feeding volumes that do not exceed that taken by healthy breastfed neonates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Necrotizing enterocolitis during the first week of life: a multicentered case–control and cohort comparison study

et al. 2008

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“…Despite major advances in the medical care of premature infants, the etiology of NEC is still incompletely understood, and has become a research priority [1].…”

Section: Introductionmentioning

confidence: 99%

Necrotizing Enterocolitis (NEC): A Devastating Disease of Prematurity

Garg¹,

Garg²,

Lal³

2015

J Neonatal Biol

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Necrotizing Enterocolitis (NEC) is a common and devastating gastrointestinal emergency that primarily affects premature infants. The incidence of necrotizing enterocolitis is 6-10% among infants with birth weight less than 1500 grams. The mortality due to NEC has not improved significantly despite advances in neonatal care and better understanding of clinical and basic sciences. The pathogenesis of NEC is not well understood and several factors such as prematurity, abnormal colonization with pathogenic bacteria, feeding practices, blood transfusion and altered intestinal barrier function may be involved. The clinical presentation of NEC could be sudden and the treatment plan could vary with the stage and type of presentation. Further research is needed to better understand the pathophysiology of NEC and, biomarkers for prediction, prevention and treatment need to be developed. Further clinical trials are needed to determine prevention and treatment modalities for this devastating disease.

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