The Role of Immunonutrients in the Prevention of Necrotizing Enterocolitis in Preterm Very Low Birth Weight Infants

Abstract

Necrotizing enterocolitis (NEC) is a critical intestinal emergency condition, which mainly occurs in preterm very low birth weight (PVLBW) infants. Despite remarkable advances in the care of PVLBW infants, with considerable improvement of the survival rate in recent decades, the incidence of NEC and NEC-related mortality have not declined accordingly. The fast progression from nonspecific signs to extensive necrosis also makes primary prevention the first priority. Recently, increasing evidence has indicated the important role of several nutrients in primary prevention of NEC. Therefore, the aim of this review is to summarize some potential immunomodulatory nutrients in the prevention of NEC, including bovine colostrum, probiotics, prebiotics (e.g., human milk oligosaccharides), long chain polyunsaturated fatty acids, and amino acids (glutamine, cysteine and N-acetylcysteine, l-arginine and l-citrulline). Based on current research evidence, probiotics are the most documented effective method to prevent NEC, while others still require further investigation in animal studies and clinical randomized controlled trials.

Necrotizing enterocolitis: new insights into pathogenesis and mechanisms

“…Moreover, these effects were shown to be partially dependent upon activation of epidermal growth factor receptor signalling 71 . Whether the development of NEC in association with formula feeding represents the presence of an injurious component in infant formula, or the deficiency of a protective agent only present in breast milk remains to be determined 37,69,124 . The lack of availability of human breast milk (which can arise for a number of reasons, such as insufficient production by the mother of an infant) remains a major challenge in neonatal care 37,69 , and has led to the use of donor breast milk as a potential substitute or supplement to formula-feeding.…”

Assessment of Nurses' Performance Regarding Care for Neonates with Necrotizing Enterocolitis at Intensive Care Units

“…Beside that, there are many evidence-based approaches to prevent NEC. These include withholding enteral feedings; using enteral antibiotics; feeding the neonate with breast milk; administering probiotic agents, or both; and administering various growth factors, anticytokine agents, and glucocorticoids (Zhou, et al, 2015).…”

Probiotic supplementation in preterm infants does not affect the risk of retinopathy of prematurity: a meta-analysis of randomized controlled trials

“…The issue of whether it is time to change practice and adopt the use of probiotics as a standard of care in preterm infants remains a hot topic for neonatologists. While some advocate a change in practice based on significant reduction in time to achieve full enteral feeding, severe NEC, LOS, and all-cause mortality 17 , 19 , 26 , 29 , 38 , 61 , others have raised concerns about the methodology of many of the published and advocate for waiting until further data on efficacy and safety in extremely preterm infants are available 16 , 62 – 65 . The evidence summarized in this meta-analysis suggests that, despite being effective in reducing LOS, probiotic supplementation does not affect the incidence of ROP in preterm infants.…”