Vitamin B12 absorption after necrotizing enterocolitis.

Resection of the terminal ileum for necrotizing enterocolitis is not uncommon in neonates requiring intensive care in the first weeks of life. They may therefore be at risk of vitamin B12 malabsorption, and later of vitamin B12 deficiency. A method of measuring B12 absorption is described and the results are given. This assessment should be part of the follow up for all these children.     

Probiotics and necrotizing enterocolitis

In this review, we summarize existing knowledge regarding the effects of probiotics on necrotizing enterocolitis (NEC). We review the role of the microbiome in NEC and pre-clinical data on mechanisms of probiotic action. Next, we summarize existing randomized controlled trials and observational studies of probiotics to prevent NEC. We also summarize findings from several recent meta-analyses and report a new cumulative meta-analysis of probiotic trials. Finally, we review data from cohorts routinely using commercially available probiotics. Our goal is to inform clinicians about the risks and benefits of probiotics, which may be helpful for those considering use in preterm infants to prevent NEC, death, or sepsis.     

Feeding and necrotizing enterocolitis

Twenty-six infants had necrotizing enterocolitis (NEC) in the neonatal unit of the Long Island Jewish-Hillside Medical Center, New Hyde Park, NY, between 1964 and 1976; 25 of these cases occurred between 1973 and 1976. The relationship of feeding practices to this clustering of NEC cases was investigated in two ways: (1) A 10% sample of all admissions, 1964 to 1976, was studied. A striking correlation was found between the yearly incidence of NEC and the percentage of infants in that year who had received large increases in daily feeding volume. The highest mean daily feeding volume occurred in 1974 and 1975, the two years of peak NEC incidence. (2) The feeding records of the 26 NEC cases were studied. Thirteen NEC patients had had large increases in feeding volume within two days of NEC onset. Seven others received greater than 150 mL of formula per kilogram per day prior to NEC onset. Rapid increase in feeding volume and the use of large volumes are suggested as important etiologic factors of NEC.     

促红细胞生成素与坏死性小肠结肠炎

新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)是新生儿期最常见的严重的胃肠道疾病,也是危及早产儿、低出生体重儿生命的疾病.NEC的发生与许多因素有关,但其确切的发病机制目前尚不十分清楚,临床上也缺少预防和治疗NEC较为有效的方法.促红细胞生成素是一种糖蛋白激素,具有抗氧化、抗凋亡、促进血管增殖等多种功能,对NEC的预防和治疗有一定的作用.     

Neonatal necrotizing enterocolitis

Necrotizing enterocolitis (NEC) remains a major cause of morbidity and death in neonates. The 30% to 50% mortality rate for NEC with perforation has not changed appreciably in the past 30 years. The critical relevant outcomes following NEC include survival, gastrointestinal function, and neurodevelopmental status. In each of these areas, initial anecdotal and case-series analysis has been followed by studies using more sophisticated methods of analysis. The single most important predictor of outcome, besides gestational age, is whether or not the disease has progressed to the point requiring surgical intervention. Patients with NEC requiring operation have a high mortality. Moreover, the vast majority of morbidity following NEC occurs in the patients who survive following operation. The purpose of this review is to examine the evolution of evidence regarding outcomes for patients with NEC and to provide an update on our current state of knowledge.     

Human milk and necrotizing enterocolitis

NEC is a multifactorial disease that occurs when multiple risk factors and/or stressors overlap, leading to profound inflammation and intestinal injury. Human milk feedings, both from the infant’s mother and donor human milk, have been associated with reductions in NEC in preterm infants. This article will review the protective factors in human milk, clinical studies of human milk and NEC, and practices to enhance human milk use in neonatal intensive care units.     

Antibiotic therapy and necrotizing enterocolitis

Antibiotic therapy remains a cornerstone of treatment of both medical and surgical presentations of necrotizing enterocolitis (NEC). However, guidelines regarding the administration of antibiotics for the treatment of NEC are lacking and practices vary amongst clinicians. Although the pathogenesis of NEC is unknown, there is consensus that the infant gastrointestinal microbiome contributes to the disease. The presumed connection between dysbiosis and NEC has prompted some to study whether early prophylactic enteral antibiotics can prevent NEC. Yet others have taken an opposing approach, studying whether perinatal antibiotic exposure increases the risk of NEC by inducing a state of dysbiosis. This narrative review summarizes what is known about antibiotics and their association with the infant microbiome and NEC, current antibiotic prescribing practices for infants with medical and surgical NEC, as well as potential strategies to further optimize the use of antibiotics in this population of infants.     

Epidemiology of necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a worldwide problem that has emerged in the past 25 years as the most common gastrointestinal emergency in neonatal intensive care units (NICU). In the United States the incidence ranges from 1 to 7.7% of NICU admissions. Ninety percent of the patients are premature infants. Mucosal injury, bacterial colonization and formula feeding are the three major pathogenetic factors that have been documented in most infants who have developed NEC. However, NEC may develop only if a threshold of injury, imposed by the coincidence of at least two of three events (intestinal ischemia, pathogenic bacteria, and excess of protein substrate) is exceeded. Immunological immaturity of the gut in premature babies may represent the crucial risk factor.     

Management and outcome of necrotizing enterocolitis

A survey of all cases of NEC in the State of Georgia during 1977 and 1978 identified 148 infants with NEC. Fifty-two of these infants were treated surgically, and the survival rate was 48 percent (26/54). The survival rate of medically treated patients was 68 percent (64/94) p less than 0.02. Survival was inversely associated with birthweight, although the survival rate following surgery was similar regardless of size. Age of presentation did not influence frequency of surgery or survival, but if perforation at surgery was present in smaller infants (less than or equal to 1500 g) the survival was less than if operation occurred prior to perforation (78% vs. 39%) p less than 0.05. The type of surgical procedure required also was associated with survival. The survival rate was greatest (90%) if only large bowel was removed and least (27%) if small bowel was resected. These results indicate the influence of birthweight, surgical procedure required, and presence or absence of perforation on survival and particularly surgical survival in NEC. They suggest that reviews of outcome in surgical management must take into account the extent of the surgical procedure that it was necessary to employ.