Journal List > Hanyang Med Rev > v.29(4) > 1044032

Lee: Prevention and Treatment of Necrotizing Enterocolitis

Abstract

Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality among premature infants. Although the pathogenesis of NEC remains unclear, recent researches revealed several associated factors of the immature intestine, with an emphasis of delayed maturation of motor and digestive function, impairment of regulation of vascular flow and intestinal barrier function, and defective immune defense. Many clinical trials have investigated the preventive role of possible disease-modification factors, but only breast feeding and antenatal steroid were proven to decrease the incidence of NEC in meta-analyses. Recent multicenter studies demonstrated a promising outcome of probiotics supplementation in the prevention of NEC, which emphasized the role of abnormal bacterial colonization in the pathogenesis of NEC. Studies on optimal choice for surgically indicated infants with NEC (laparatomy versus primary peritoneal drainage) still remain inconclusive. As NEC is a disease with a multifactorial etiology, combinations of current evidence in practice are required to reduce the incidence of NEC.

Figures and Tables

Table 1
Treatment according to the classification of necrotizing enterocolitis (Modified Bell's Staging Criteria).
hmr-29-346-i001

References

1. Guillet R, Stoll BJ, Cotten CM, Gantz M, McDonald S, Poole WK, Phelps DL. Association of H2-blocker therapy and higher incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics. 2006; 117:e137–e142.
crossref
2. Horbar JD, Badger GJ, Carpenter JH, Fanaroff AA, Kilpatrick S, LaCorte M, Phibbs R, Soll RF. Trends in mortality and morbidity for very low birth weight infants,1991-1999. Pediatrics. 2002; 110:143–151.
crossref
3. Ma TH, Lee YK, Kim KA, Ko SY, Kim MJ, Shin SM. Outcome of Very Low Birth Weight Infants in Past 2 Years at Samsung Cheil Hospital. J Korean Soc Neonatol. 2003; 10:7–13.
4. Park MR, Lee BS, Kim EA, Kim KS, Pi SY. Outcomes of Extremely Low Birth Weight Infants at the Asan Medical Center between 2003 and 2006. J Korean Soc Neonatol. 2008; 15:123–133.
5. Wang SW, Lee YA, Park SE, Shin JB, Hong YR, Park JJ, Lee JA, Son SH, Byun SO, Kim JP. Changes in the Outcomes of Very Low Birth Weight Infants in Busan Area. J Korean Soc Neonatol. 2007; 14:206–214.
6. Holman RC, Stoll BJ, Curns AT, Yorita KL, Steiner CA, Schonberger LB. Necrotising enterocolitis hospitalisations among neonates in the United States. Paediatr Perinat Epidemiol. 2006; 20:498–506.
crossref
7. Hintz SR, Kendrick DE, Stoll BJ, Vohr BR, Fanaroff AA, Donovan EF, Poole WK, Blakely ML, Wright L, Higgins R. Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis. Pediatrics. 2005; 115:696–703.
crossref
8. Vohr BR, Wright LL, Dusick AM, Mele L, Verter J, Steichen JJ, Simon NP, Wilson DC, Broyles S, Bauer CR, Delaney-Black V, Yolton KA, Fleisher BE, Papile LA, Kaplan MD. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. Pediatrics. 2000; 105:1216–1226.
crossref
9. Sanderson IR. The physicochemical environment of the neonatal intestine. Am J Clin Nutr. 1999; 69:1028S–1034S.
crossref
10. Ostlie DJ, Spilde TL, St Peter SD, Sexton N, Miller KA, Sharp RJ, Gittes GK, Snyder CL. Necrotizing enterocolitis in full-term infants. J Pediatr Surg. 2003; 38:1039–1042.
crossref
11. Amin HJ, Zamora SA, McMillan DD, Fick GH, Butzner JD, Parsons HG, Scott RB. Arginine supplementation prevents necrotizing enterocolitis in the premature infant. J Pediatr. 2002; 140:425–431.
crossref
12. Lebenthal A, Lebenthal E. The ontogeny of the small intestinal epithelium. JPEN J Parenter Enteral Nutr. 1999; 23:S3–S6.
crossref
13. Upperman JS, Potoka D, Grishin A, Hackam D, Zamora R, Ford HR. Mechanisms of nitric oxide-mediated intestinal barrier failure in necrotizing enterocolitis. Semin Pediatr Surg. 2005; 14:159–166.
crossref
14. Warner BW, Warner BB. Role of epidermal growth factor in the pathogenesis of neonatal necrotizing enterocolitis. Semin Pediatr Surg. 2005; 14:175–180.
crossref
15. Shin CE, Falcone RA Jr, Stuart L, Erwin CR, Warner BW. Diminished epidermal growth factor levels in infants with necrotizing enterocolitis. J Pediatr Surg. 2000; 35:173–176. discussion 177.
crossref
16. Scott MG, Hancock RE. Cationic antimicrobial peptides and their multifunctional role in the immune system. Crit Rev Immunol. 2000; 20:407–431.
crossref
17. Ganz T. Defensins: antimicrobial peptides of innate immunity. Nat Rev Immunol. 2003; 3:710–720.
crossref
18. Salzman NH, Underwood MA, Bevins CL. Paneth cells, defensins, and the commensal microbiota: a hypothesis on intimate interplay at the intestinal mucosa. Semin Immunol. 2007; 19:70–83.
crossref
19. Kelly D, Campbell JI, King TP, Grant G, Jansson EA, Coutts AG, Pettersson S, Conway S. Commensal anaerobic gut bacteria attenuate inflammation by regulating nuclear-cytoplasmic shuttling of PPAR-gamma and RelA. Nat Immunol. 2004; 5:104–112.
crossref
20. Leaphart CL, Cavallo J, Gribar SC, Cetin S, Li J, Branca MF, Dubowski TD, Sodhi CP, Hackam DJ. A critical role for TLR4 in the pathogenesis of necrotizing enterocolitis by modulating intestinal injury and repair. J Immunol. 2007; 179:4808–4820.
crossref
21. Lu J, Jilling T, Li D, Caplan MS. Polyunsaturated fatty acid supplementation alters proinflammatory gene expression and reduces the incidence of necrotizing enterocolitis in a neonatal rat model. Pediatr Res. 2007; 61:427–432.
crossref
22. Bombell S, McGuire W. Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev. 2008; CD001970.
crossref
23. Berseth CL, Bisquera JA, Paje VU. Prolonging small feeding volumes early in life decreases the incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics. 2003; 111:529–534.
crossref
24. Menon G, Boyle EM, Embleton ND, McIntosh N. Introduction of enteral feeds in preterm infants. Pediatrics. 2004; 114:327–328.
crossref
25. Tyson JE, Kennedy KA. Trophic feedings for parenterally fed infants. Cochrane Database Syst Rev. 2005; CD000504.
crossref
26. McGuire W, Bombell S. Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev. 2008; CD001241.
crossref
27. Quigley MA, Henderson G, Anthony MY, McGuire W. Formula milk versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2007; CD002971.
crossref
28. Lee JS, Polin RA. Treatment and prevention of necrotizing enterocolitis. Semin Neonatol. 2003; 8:449–459.
crossref
29. Hallstrom M, Koivisto AM, Janas M, Tammela O. Frequency of and risk factors for necrotizing enterocolitis in infants born before 33 weeks of gestation. Acta Paediatr. 2003; 92:111–113.
crossref
30. Eibl MM, Wolf HM, Furnkranz H, Rosenkranz A. Prevention of necrotizing enterocolitis in low-birth-weight infants by IgA-IgG feeding. N Engl J Med. 1988; 319:1–7.
crossref
31. Foster J, Cole M. Oral immunoglobulin for preventing necrotizing enterocolitis in preterm and low birth-weight neonates. Cochrane Database Syst Rev. 2004; CD001816.
crossref
32. Neu J, Roig JC, Meetze WH, Veerman M, Carter C, Millsaps M, Bowling D, Dallas MJ, Sleasman J, Knight T, Auestad N. Enteral glutamine supplementation for very low birth weight infants decreases morbidity. J Pediatr. 1997; 131:691–699.
crossref
33. Tubman TR, Thompson SW, McGuire W. Glutamine supplementation to prevent morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2008; CD001457.
crossref
34. Boccia D, Stolfi I, Lana S, Moro ML. Nosocomial necrotising enterocolitis outbreaks: epidemiology and control measures. Eur J Pediatr. 2001; 160:385–391.
crossref
35. Bury RG, Tudehope D. Enteral antibiotics for preventing necrotizing enterocolitis in low birthweight or preterm infants. Cochrane Database Syst Rev. 2001; CD000405.
crossref
36. Cotten CM, Taylor S, Stoll B, Goldberg RN, Hansen NI, Sanchez PJ, Ambalavanan N, Benjamin DK. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics. 2009; 123:58–66.
crossref
37. Deshpande G, Rao S, Patole S. Probiotics for prevention of necrotising enterocolitis in preterm neonates with very low birthweight: a systematic review of randomised controlled trials. Lancet. 2007; 369:1614–1620.
crossref
38. Caplan MS, Miller-Catchpole R, Kaup S, Russell T, Lickerman M, Amer M, Xiao Y, Thomson R. Bifidobacterial supplementation reduces the incidence of necrotizing enterocolitis in a neonatal rat model. Gastroenterology. 1999; 117:577–583.
crossref
39. Claud EC, Walker WA. Hypothesis: inappropriate colo necrotizing enterocolitis. FASEB J. 2001; 15:1398–1403.
40. Alfaleh K, Bassler D. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev. 2008; CD005496.
crossref
41. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006; 3:CD004454.
crossref
42. Halliday HL, Ehrenkranz RA, Doyle LW. Delayed (3 weeks) postnatal corticosteroids for chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2003; CD001145.
crossref
43. Halliday HL, Ehrenkranz RA, Doyle LW. Late (7 days) postnatal corticosteroids for chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2009; CD001145.
crossref
44. Halliday HL, Ehrenkranz RA, Doyle LW. Early (8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants. Cochrane Database Syst Rev. 2009; CD001146.
45. Feng J, El-Assal ON, Besner GE. Heparin-binding epidermal growth factor-like growth factor reduces intestinal apoptosis in neonatal rats with necrotizing enterocolitis. J Pediatr Surg. 2006; 41:742–747. discussion 742-7.
crossref
46. Nair RR, Warner BB, Warner BW. Role of epidermal growth factor and other growth factors in the prevention of necrotizing enterocolitis. Semin Perinatol. 2008; 32:107–113.
crossref
47. Faingold R, Daneman A, Tomlinson G, Babyn PS, Manson DE, Mohanta A, Moore AM, Hellmann J, Smith C, Gerstle T, Kim JH. Necrotizing Enterocolitis: Assessment of Bowel Viability with Color Doppler US1. Radiology. 2005; 235:587–594.
crossref
48. Pierro A, Hall N, Ade-Ajayi A, Curry J, Kiely Em EM. Laparoscopy assists surgical decision making in infants with necrotizing enterocolitis. J Pediatr Surg. 2004; 39:902–906. discussion 902-6.
crossref
49. Moss RL, Dimmitt RA, Henry MC, Geraghty N, Efron B. A meta-analysis of peritoneal drainage versus laparotomy for perforated necrotizing enterocolitis. J Pediatr Surg. 2001; 36:1210–1213.
crossref
50. Moss RL, Dimmitt RA, Barnhart DC, Sylvester KG, Brown RL, Powell DM, Islam S, Langer JC, Sato TT, Brandt ML, Lee H, Blakely ML, Lazar EL, Hirschl RB, Kenney BD, Hackam DJ, Zelterman D, Silverman BL. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med. 2006; 354:2225–2234.
crossref
51. Rees CM, Eaton S, Kiely EM, Wade AM, McHugh K, Pierro A. Peritoneal drainage or laparotomy for neonatal bowel perforation? A randomized controlled trial. Ann Surg. 2008; 248:44–51.
52. Blakely ML, Tyson JE, Lally KP, McDonald S, Stoll BJ, Stevenson DK, Poole WK, Jobe AH, Wright LL, Higgins RD. Laparotomy versus peritoneal drainage for necrotizing enterocolitis or isolated intestinal perforation in extremely low birth weight infants: outcomes through 18 months adjusted age. Pediatrics. 2006; 117:e680–e687.
crossref
53. Chwals WJ, Blakely ML, Cheng A, Neville HL, Jaksic T, Cox CS, Lally KP. Surgery-associated complications in necrotizing enterocolitis: A multiinstitutional study. J Pediatr Surg. 2001; 36:1722–1724.
crossref
54. Ambalavanan N, Nelson KG, Alexander G, Johnson SE, Biasini F, Carlo WA. Prediction of neurologic morbidity in extremely low birth weight infants. J Perinatol. 2000; 20:496–503.
crossref
55. Ford H, Watkins S, Reblock K, Rowe M. The role of inflammatory cytokines and nitric oxide in the pathogenesis of necrotizing enterocolitis. J Pediatr Surg. 1997; 32:275–282.
crossref
56. Yoon BH, Park CW, Chaiworapongsa T. Intrauterine infection and the development of cerebral palsy. BJOG. 2003; 110:Suppl 20. 124–127.
crossref
57. Hack M, Breslau N, Weissman B, Aram D, Klein N, Borawski E. Effect of very low birth weight and subnormal head size on cognitive abilities at school age. N Engl J Med. 1991; 325:231–237.
crossref
TOOLS
Similar articles