Optimizing Nutritional Strategies to Prevent Necrotizing Enterocolitis and Growth Failure after Bowel Resection

Abstract

Necrotizing enterocolitis (NEC), the first cause of short bowel syndrome (SBS) in the neonate, is a serious neonatal gastrointestinal disease with an incidence of up to 11% in preterm newborns less than 1500 g of birth weight. The rate of severe NEC requiring surgery remains high, and it is estimated between 20–50%. Newborns who develop SBS need prolonged parenteral nutrition (PN), experience nutrient deficiency, failure to thrive and are at risk of neurodevelopmental impairment. Prevention of NEC is therefore mandatory to avoid SBS and its associated morbidities. In this regard, nutritional practices seem to play a key role in early life. Individualized medical and surgical therapies, as well as intestinal rehabilitation programs, are fundamental in the achievement of enteral autonomy in infants with acquired SBS. In this descriptive review, we describe the most recent evidence on nutritional practices to prevent NEC, the available tools to early detect it, the surgical management to limit bowel resection and the best nutrition to sustain growth and intestinal function.

Neurologic Consequences of Neonatal Necrotizing Enterocolitis

“…Outcome studies indicate that in addition to the severity of gut damage, presence of persistent mucosal and systemic inflammation, and need for bowel resection, concomitant sepsis [84, 85], lung disease of prematurity (e.g., bronchopulmonary dysplasia) [9], nutritional deficiencies due to feeding intolerance, and continued gut dysbiosis exacerbated by the early use of antibiotics [66, 86] contribute to worse NDI in NEC. This lends support to a multifactorial etiology of neurologic injury in NEC.…”

Imaging manifestations of neonatal necrotizing enterocolitis to predict timing of surgery

“…4 The main purpose of surgical treatment for NEC children is to remove the necrotic intestinal tissue as completely as possible to reduce the abdominal inflammatory condition and preserve the intestinal tissue to avoid the occurrence of short bowel syndrome. 11 However, this indication is difficult to grasp in clinical work. Pneumoperitoneum, abdominal wall redness, abdominal mass, and intestinal obstruction are considered as indications for early surgical operation.…”

Providing the Best Parenteral Nutrition before and after Surgery for NEC: Macro and Micronutrients Intakes

“…During the recovery phase, with restoration of fecal output, water and electrolyte losses are often observed, in particular in the presence of enterostomy, hence it is important to carefully monitor fecal output and restore the losses [ 17 ]. Excessive fluid loss from stoma, defined as losses >30 mL/kg/day, might be frequently detected post-surgery requiring prompt diagnosis and treatment to avoid dehydration, electrolyte imbalance, and poor growth [ 46 ]. Prematurity, the inflammatory status, and antibiotics contribute to the high stoma losses that need to be replaced intravenously.…”