Nutrition in Necrotizing Enterocolitis and Following Intestinal Resection

Abstract

This review aims to discuss the role of nutrition and feeding practices in necrotizing enterocolitis (NEC), NEC prevention, and its complications, including surgical treatment. A thorough PubMed search was performed with a focus on meta-analyses and randomized controlled trials when available. There are several variables in nutrition and the feeding of preterm infants with the intention of preventing necrotizing enterocolitis (NEC). Starting feeds later rather than earlier, advancing feeds slowly and continuous feeds have not been shown to prevent NEC and breast milk remains the only effective prevention strategy. The lack of medical treatment options for NEC often leads to disease progression requiring surgical resection. Following resection, intestinal adaptation occurs, during which villi lengthen and crypts deepen to increase the functional capacity of remaining bowel. The effect of macronutrients on intestinal adaptation has been extensively studied in animal models. Clinically, the length and portion of intestine that is resected may lead to patients requiring parenteral nutrition, which is also reviewed here. There remain significant gaps in knowledge surrounding many of the nutritional aspects of NEC and more research is needed to determine optimal feeding approaches to prevent NEC, particularly in infants younger than 28 weeks and <1000 grams. Additional research is also needed to identify biomarkers reflecting intestinal recovery following NEC diagnosis individualize when feedings should be safely resumed for each patient.

Keywords: breast milk; hormones; intestinal adaptation; intestinal resection; microbiome; necrotizing enterocolitis; parenteral nutrition; prematurity; short bowel syndrome.

Figure 1

Summary of the Pathophysiology, Treatment Strategies, and Unknowns of Necrotizing Enterocolitis. The pathophysiology of NEC is multi-faceted, involving intestinal barrier dysfunction, decreased IgA, and altered microbiota. Current treatment strategies include stopping feeds and starting antibiotics based on disease severity, as classified by Bell’s staging. Much remains unknown about disease prevention, diagnosis, and treatment. Figure created with Biorender.com. Abbreviations: Immunoglobulin A (IgA), NEC (Necrotizing enterocolitis), NPO (nil per os).