From the Guidelines
Necrotizing enterocolitis (NEC) requires immediate medical attention, with the initial treatment involving broad-spectrum antibiotics, gastric decompression, and supportive care, as well as consideration for surgical intervention in severe cases, as indicated by the most recent guidelines 1. The management of NEC involves a multidisciplinary approach, with the goal of reducing morbidity, mortality, and improving quality of life.
- The initial treatment of NEC is medical, with the administration of broad-spectrum antibiotics, such as piperacillin-tazobactam or imipenem-cilastatin, or combination therapy with cefepime or ceftazidime along with metronidazole, as recommended by recent guidelines 1.
- Gastric decompression via nasogastric tube, i.v. fluids, bowel rest, and serial abdominal examinations are also essential components of medical management 1.
- Surgical intervention is necessary in cases with intestinal perforation, clinical deterioration despite medical management, or other indications such as persistent gastrointestinal bleeding, abscess formation, or evidence of free intraperitoneal perforation 1.
- The use of anticholinergic, antidiarrheal, and opioid agents should be avoided, as they may aggravate ileus 1.
- Blood transfusions may be necessary in cases with bloody diarrhea 1.
- The pathophysiology of NEC involves intestinal immaturity, abnormal bacterial colonization, and inflammatory cascade activation leading to mucosal injury, and early recognition and prompt treatment are crucial to improve outcomes 1.
- Prevention strategies, such as preferential use of human milk, standardized feeding protocols with slow advancement, probiotics in high-risk infants, and avoiding hyperosmolar formulas and medications, are also essential to reduce the risk of NEC 1.
From the Research
Definition and Overview of Necrotizing Enterocolitis
- Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal tract characterized by ischemic necrosis of the intestinal mucosa, mostly affecting premature neonates 2.
- It is the leading cause of death due to gastrointestinal disease in preterm neonates, affecting 5–12% of neonates born at a very-low birth weight 3.
Treatment and Management of NEC
- Management of NEC includes medical care and surgical approaches, with supportive care and empirical antibiotic therapy recommended to avoid any disease progression 2.
- Antibiotic therapy remains a cornerstone of treatment of both medical and surgical presentations of NEC, but guidelines regarding the administration of antibiotics for the treatment of NEC are lacking and practices vary amongst clinicians 4.
- The use of ampicillin and gentamicin is effective in decreasing mortality and preventing clinical deterioration in NEC, and metronidazole could be added in patients with surgical NEC 2, 5.
Antibiotic Therapy and NEC
- The presumed connection between dysbiosis and NEC has prompted some to study whether early prophylactic enteral antibiotics can prevent NEC, while others have taken an opposing approach, studying whether perinatal antibiotic exposure increases the risk of NEC by inducing a state of dysbiosis 4.
- Antibiotic use for NEC varies substantially without definite outcome differences, and narrow-spectrum and shorter course NEC treatment may be preferred due to growing concern for short and longer term adverse effects with early-life antibiotic exposure 5.
Prevention and Risk Factors of NEC
- Intestinal microbial composition may play a key role in determining which infants are predisposed to NEC and when infants are at highest risk of developing NEC 6.
- Risk factors for NEC include prematurity, and dysbiosis in preterm infants may play a role in the pathogenesis of NEC 3, 6.
- Probiotic and antibiotic therapy may be used to prevent and/or treat NEC and its sequelae, but it is unclear how to optimize antibiotic therapy in preterm infants to prevent NEC 6.