title: Necrotizing enterocolitis in newborns: update in pathophysiology and newly emerging therapeutic strategies.
abstract: While the survival of extremely premature infants with respiratory distress syndrome has increased due to advanced respiratory care in recent years, necrotizing enterocolitis (NEC) remains the leading cause of neonatal mortality and morbidity. NEC is more prevalent in lower gestational age and lower birth weight groups. It is characterized by various degrees of mucosal or transmural necrosis of the intestine. Its exact pathogenesis remains unclear, but prematurity, enteral feeding, bacterial products, and intestinal ischemia have all been shown to cause activation of the inflammatory cascade, which is known as the final common pathway of intestinal injury. Awareness of the risk factors for NEC; practices to reduce the risk, including early trophic feeding with breast milk and following the established feeding guidelines; and administration of probiotics have been shown to reduce the incidence of NEC. Despite advancements in the knowledge and understanding of the pathophysiology of NEC, there is currently no universal prevention measure for this serious and often fatal disease. Therefore, new potential techniques to detect early biomarkers or factors specific to intestinal inflammation, as well as further strategies to prevent the activation of the inflammatory cascade, which is important for disease progression, should be investigated.
authors: Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
authors: Young Youn
authors: YY
authors: Choi
keywords: Extremely premature infants; Necrotizing enterocolitis; Pathophysiology; Prevention; Risk factor
references: Proc Natl Acad Sci U S A. 2012 Jul 10;109(28):11330-5
references: 22733781
references: Gastroenterology. 2010 Jan;138(1):185-96
references: 19786028
references: Biomed Res Int. 2014;2014:543765
references: 25147804
references: J Pediatr. 2007 Apr;150(4):358-63
references: 17382110
references: Eur J Clin Nutr. 2011 Apr;65(4):434-9
references: 21245887
references: J Pediatr. 2005 Aug;147(2):192-6
references: 16126048
references: J Immunol. 2007 Oct 1;179(7):4808-20
references: 17878380
references: Int J Infect Dis. 1999 Summer;3(4):197-202
references: 10575148
references: J Pediatr Gastroenterol Nutr. 2005 Feb;40(2):184-8
references: 15699694
references: Cytokine. 2010 Aug;51(2):119-26
references: 20347329
references: Pediatrics. 2005 Jan;115(1):1-4
references: 15629973
references: J Clin Microbiol. 2001 Jan;39(1):293-7
references: 11136786
references: J Pediatr. 2009 Nov;155(5):S61-70
references: 19840609
references: J Pediatr Surg. 2010 Apr;45(4):729-34
references: 20385279
references: N Engl J Med. 2001 Jan 11;344(2):95-101
references: 11150359
references: J Matern Fetal Neonatal Med. 2012 Apr;25 Suppl 1:128-31
references: 22339378
references: Pediatrics. 2013 Jan;131(1):e318-22
references: 23230079
references: J Trop Pediatr. 2009 Apr;55(2):128-31
references: 18842610
references: J Immunol. 2012 May 1;188(9):4543-57
references: 22461698
references: J Pediatr Gastroenterol Nutr. 2012 May;54(5):639-44
references: 22002480
references: Cell Host Microbe. 2012 Nov 15;12(5):611-22
references: 23159051
references: Pediatr Res. 2007 Oct;62(4):510-4
references: 17667844
references: Pediatrics. 2010 Sep;126(3):443-56
references: 20732945
references: Am J Perinatol. 2006 Nov;23(8):451-8
references: 17009195
references: J Pediatr Surg. 1998 Feb;33(2):243-54
references: 9498395
references: Clin Nutr. 2012 Feb;31(1):6-15
references: 21996513
references: Semin Perinatol. 2008 Apr;32(2):107-13
references: 18346534
references: J Pediatr. 1990 Jul;117(1 Pt 2):S6-13
references: 2362230
references: Cochrane Database Syst Rev. 2014 Apr 10;(4):CD005496
references: 24723255
references: Am J Clin Nutr. 2013 Dec;98(6):1468-74
references: 24025633
references: Acta Paediatr. 2012 Nov;101(11):1121-7
references: 22845166
references: Biol Neonate. 2002 Aug;82(2):103-8
references: 12169832
references: J Pediatr. 2010 Apr;156(4):562-7.e1
references: 20036378
references: Acta Paediatr Suppl. 2005 Oct;94(449):100-5
references: 16214774
references: Ann Surg. 2013 Dec;258(6):1111-8
references: 23470582
references: Am J Obstet Gynecol. 2007 Feb;196(2):147.e1-8
references: 17306659
references: JPEN J Parenter Enteral Nutr. 2013 Sep;37(5):617-22
references: 23329787
references: Semin Pediatr Surg. 2008 Nov;17(4):255-65
references: 19019294
references: Clin Infect Dis. 2008 Feb 1;46 Suppl 2:S87-91; discussion S144-51
references: 18181730
references: Adv Exp Med Biol. 2000;478:77-93
references: 11065062
references: Pediatrics. 2008 Oct;122(4):693-700
references: 18829790
references: PLoS One. 2011;6(6):e20647
references: 21674011
references: BMC Microbiol. 2011 Apr 12;11:73
references: 21486476
references: Cochrane Database Syst Rev. 2000;(2):CD000504
references: 10796374
references: J Perinatol. 2009 Jan;29(1):57-62
references: 18716628
references: J Gastrointest Surg. 2008 Mar;12(3):429-35; discussion 435-6
references: 18092190
references: J Pediatr Surg. 2002 Aug;37(8):1177-82
references: 12149697
references: Clin Perinatol. 1994 Jun;21(2):219-34
references: 8070223
references: J Pediatr. 1994 May;124(5 Pt 1):795-9
references: 8176571
references: Pediatr Clin North Am. 1986 Feb;33(1):179-201
references: 3081865
references: Cochrane Database Syst Rev. 2004;(1):CD000343
references: 14973953
references: Am J Perinatol. 2013 Nov;30(10):849-56
references: 23359235
references: Gastroenterology. 2006 Feb;130(2):359-72
references: 16472592
references: Trends Immunol. 2002 Mar;23(3):130-5
references: 11864840
references: J Pediatr Gastroenterol Nutr. 2002 Oct;35(4):545-50
references: 12394382
references: Semin Fetal Neonatal Med. 2006 Oct;11(5):369-77
references: 16690363
references: Ann Surg. 1978 Jan;187(1):1-7
references: 413500
references: Pediatrics. 2000 Feb;105(2):379-84
references: 10654959
references: J Immunol. 2013 Apr 1;190(7):3541-51
references: 23455503
references: J Biol Chem. 2011 Apr 8;286(14):12123-32
references: 21262973
references: J Pediatr. 1965 Apr;66:697-705
references: 14271359