Evidence vs experience in neonatal practices in necrotizing enterocolitis.
BACKGROUND
Necrotizing enterocolitis (NEC) has been recognized for over 40 years as a cause of inflammation and necrosis of the small and large intestine of infants born at less than 36 weeks of gestation. NEC remains a significant health problem for infants born prematurely and may become the leading cause of morbidity and mortality among these infants worldwide. The sequence of events leading to NEC is complex and multifactorial, although damage to the intestinal epithelium and invasion by bacteria are known to play central roles in disease pathogenesis.


METHODS
Bacteria initiate a cascade of inflammation that may progress to intestinal necrosis and perforation with sepsis and death.


RESULTS
Treatment of infants at risk for NEC with probiotic bacteria may be an area of great potential, as probiotic bacteria may promote maturation of the epithelial barrier and function to exclude bacterial pathogens from critical niches in the intestine, thereby disrupting a primary pathway in disease pathogenesis.


CONCLUSIONS
Understanding how probiotic bacteria, or other novel therapies, prevent or limit disease propagation in NEC will be paramount in limiting the impact of disease in a growing population of premature newborns.
Hunter
C J
CJ
Department of Surgery, Keck School of Medicine, Childrens Hospital Los Angeles, University of Southern California, Los Angeles, CA 90027, USA.
Podd
B
B
Ford
H R
HR
Camerini
V
V
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D020345:Enterocolitis, Necrotizing / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D015931:Intensive Care, Neonatal; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D019936:Probiotics / Q000627:therapeutic use*; D011361:Professional Competence; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D012151:Resuscitation
D000900:Anti-Bacterial Agents