From the Guidelines
Necrotizing enterocolitis (NEC) is primarily caused by prematurity, with approximately 90% of cases occurring in preterm infants, and the most significant risk factors include low birth weight, formula feeding instead of breast milk, intestinal ischemia, and abnormal bacterial colonization of the gut. The pathogenesis of NEC typically involves a combination of these factors leading to intestinal inflammation, bacterial invasion, and ultimately tissue death in portions of the bowel, which can progress to perforation and sepsis if not promptly treated 1.
Risk Factors
Some of the key risk factors for NEC include:
- Low birth weight
- Formula feeding instead of breast milk
- Intestinal ischemia
- Abnormal bacterial colonization of the gut
- Prolonged antibiotic use, which disrupts normal gut flora
- Congenital heart defects that compromise intestinal blood flow
- Severe illness in newborns requiring intensive care
- Maternal factors such as placental insufficiency, preeclampsia, and cocaine use during pregnancy, which may reduce blood flow to the fetus 1.
Pathogenesis
The pathogenesis of NEC involves a complex interplay of factors, including:
- Immature intestinal barriers in premature infants that allow bacteria to invade the intestinal wall
- Reduced blood flow to the intestines
- Formula feeding, which lacks protective factors found in breast milk
- Abnormal bacterial colonization of the gut, which can lead to an imbalance of the gut microbiome 1.
Prevention and Treatment
Prevention and treatment of NEC typically involve a combination of strategies, including:
- Breast milk feeding
- Probiotic supplementation, which has been shown to reduce the incidence of NEC in preterm infants 1
- Careful monitoring of intestinal blood flow and perfusion
- Prompt treatment of any underlying infections or illnesses
- Surgical intervention, if necessary, to remove any affected portions of the bowel 1.
Overall, NEC is a complex and multifactorial disease, and a comprehensive understanding of its causes, risk factors, and pathogenesis is essential for the development of effective prevention and treatment strategies.
From the Research
Common Causes of Necrotizing Enterocolitis
The common causes of necrotizing enterocolitis (NEC) are multifactorial and not fully understood. However, several potential contributing factors have been identified, including:
- Prematurity 2, 3, 4
- Formula-feeding 3
- Infection 2, 3, 4
- Microbial dysbiosis 3, 5
- Introduction and advancement of enteric feeding 2
- Alterations in the normal bacterial colonization of the GI tract 2
- Bacterial translocation and activation of the cytokine cascade 2
- Decreased epidermal growth factor 2
- Increased platelet activating factor 2
- Mucosal damage from free radical production 2
Risk Factors
Several risk factors have been identified, including:
- Very low birth weight (<1500 g) 2, 6
- Gestational age less than or equal to 34 weeks 6
- Birth weight less than or equal to 1,500 grams 6
Pathogenesis
The pathogenesis of NEC is complex and involves a combination of factors, including: