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Nutritional Interventions for Necrotizing Enterocolitis
Necrotizing enterocolitis (NEC), which is characterized by severe intestinal inflammation and in advanced stages necrosis, is a gastrointestinal emergency in the neonate with high mortality and morbidity. Despite advancing medical care, effective prevention strategies remain sparse. Factors contributing to the complex pathogenesis of NEC include immaturity of the intestinal immune defense, barrier function, motility and local circulatory regulation and abnormal microbial colonization. Interestingly, enteral feeding is regarded as an important modifiable factor influencing NEC pathogenesis. Moreover, breast milk, which forms the currently most effective prevention strategy, contains many bioactive components that are known to support neonatal immune development and promote healthy gut colonization. This systematic review describes the effect of different enteral feeding interventions on the prevention of NEC incidence and severity and the effect on pathophysiological mechanisms of NEC, in both experimental NEC models and clinical NEC. Besides, pathophysiological mechanisms involved in human NEC development are briefly described to give context for the findings of altered pathophysiological mechanisms of NEC by enteral feeding interventions.
Necrotizing enterocolitis (NEC) is a multifactorial disease, characterized by severe intestinal inflammation and, in advancing disease, gut necrosis, that mainly affects premature neonates . Around 5 to 10% of very low birth weight (VLBW) infants develop NEC, with the highest incidence among neonates with an extremely low birth weight (ELBW) . Despite advancing medical care, NEC incidence has not substantially decreased over time, mainly due to increased early survival of neonates . NEC mortality is inversely correlated with birth weight and generally ranges from 15% to 30% . However, case fatality can increase up to 50% for ELBW infants treated surgically . Being responsible for 10% of NICU deaths, NEC represents an important cause of death in this setting . Moreover, infants that do recover from NEC suffer from several long-term morbidities such as growth retardation , short bowel syndrome , intestinal failure , intestinal failure-associated liver disease and neurodevelopmental delays . Although the precise healthcare costs of NEC are difficult to estimate , the costs undoubtedly exceed those of matched controls, with estimates of around $70,000 extra hospital costs for medical NEC and around $180,000 for surgical NEC . Moreover, life-long care for patients with morbidities following NEC will impose an even higher financial burden on both society and the individual patient . NEC thus forms an important health issue that has high impact on the patient and its parents and also leads to a significant economic burden.
2. Development and Findings
The entry is from 10.3390/nu13051726
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