Evidence vs experience in neonatal practices in necrotizing enterocolitis

Abstract

Introduction: Necrotizing enterocolitis (NEC) has been recognized for over 40 years as a cause of inflammation and necrosis of the small and large intestine of infants born at less than 36 weeks of gestation. NEC remains a significant health problem for infants born prematurely and may become the leading cause of morbidity and mortality among these infants worldwide. The sequence of events leading to NEC is complex and multifactorial, although damage to the intestinal epithelium and invasion by bacteria are known to play central roles in disease pathogenesis.

Study design: Bacteria initiate a cascade of inflammation that may progress to intestinal necrosis and perforation with sepsis and death.

Result: Treatment of infants at risk for NEC with probiotic bacteria may be an area of great potential, as probiotic bacteria may promote maturation of the epithelial barrier and function to exclude bacterial pathogens from critical niches in the intestine, thereby disrupting a primary pathway in disease pathogenesis.

Conclusion: Understanding how probiotic bacteria, or other novel therapies, prevent or limit disease propagation in NEC will be paramount in limiting the impact of disease in a growing population of premature newborns.

Figure 1

Radiographic findings in necrotizing enterocolitis and spontaneous intestinal perforation. (a) Supine abdominal X-ray in a neonate demonstrating thickened bowel walls, bowel distention, pneumatosis intestinalis and the outline of the falciform ligament indicative of free abdominal air. This patient was subsequently diagnosed with necrotizing enterocolitis. (b) A cross-table lateral view shows free air in the abdomen in a premature infant with spontaneous intestinal perforation (SIP).