Recent developments in necrotizing enterocolitis (NEC) have focused on the potential role of new biomarkers and preventive strategies (JPEN 2012; 36: 30S-35S). In this report, the clinical/diagnostic features of NEC are reviewed:
- classic form develops between 29-32 weeks corrected gestational age
- features include feeding intolerance, abdominal distention, bloody stools
- imaging features: pneumotosis intestinalis, portal venous gas, paucity of gas, fixed bowel loops
- full term or late NEC usually occurs in the setting of risk factors like congenital heart disease, exchange transfusions, gastroschisis, and neural tube defects
- spontaneous intestinal perforation due to glucocorticoids or indomethacin may be confused with NEC. It usually occurs earlier than NEC
This review describes the potential for new biomarkers, including urinary I-FABP & fecal calprotectin. These assays would need to be available with very short turn-around time given the often rapid development of NEC.
Finally, this articles discusses the evidence for preventive measures. Human milk has been shown to decrease NEC and gradual introduction of feedings remains important. With regard to microbial colonization, NEC does not occur until at least 8-10 days postpartum coincident with anerobic bacterial colonization of intestinal tract.
This has led to attempts to alter the colonization to decrease NEC incidence. 16 randomized controlled trials with 14 different probiotics have been completed. Most are underpowered. “The available trials do not permit a decision to be made with respect to optimum strain, dosing, or protocol.” In a cautionary note, a preterm pig model demonstrated an increase NEC incidence with the use of a specific probiotic (Pediatr Res 2011; 69: 10-16). Furthermore, probiotics are plagued by a lack of adequate quality control.
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- -J Peds 2011; 159: 392. n=124 cases (248 controls). retrospective study suggested that abx exposure is a risk factor for NEC (3-fold risk). Abx -marker for illness or true predisposing factor?
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- -Pediatrics 2007; 119; e164. Rate of 0.4% among large cohort of infants w/o indocin, steroids & w slow delayed feedings.
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- -J Pediatr 2003; 143: 543. Images of pneumotosis.