Prevention and treatment of necrotising enterocolitis in preterm neonates

Abstract

Necrotising enterocolitis (NEC) is a potentially disastrous illness in preterm, especially extremely preterm (gestation under 28 weeks) neonates with significant mortality, and morbidity including long term neurodevelopmental impairment. With improved survival of neonates at the limits of viability, the size of the population at risk for NEC has increased in recent years. NEC is a common cause of death in preterm neonates who survive the first week of life. The estimated annual economic burden related to NEC is close a billion dollar in the USA. Prevention and treatment of NEC has thus become a priority. Recent research has improved the understanding of the role of innate immunity in the pathogenesis of NEC. As new frontiers like probiotics and lactoferrin continue to be explored, the impact of well-established simple strategies like antenatal glucocorticoid therapy, and early and preferential use of breast milk should not be forgotten for primary prevention of NEC. Clinical research is needed on feed intolerance, safety of minimal enteral feeds in terms of NEC, and benefits of standardised feeding regimens. Association of common clinical practices such as red cell transfusions, H2 receptor blockade, undue prolonged antibiotic treatment, and thickening of feeds with NEC also warrants attention. Evaluating potential strategies for secondary prophylaxis (e.g., pentoxifylline) is equally important considering the fact that almost the entire health burden of NEC is related to progression of the illness from Stage II to Stage III. A package of potentially better practices seems to be the most appropriate strategy for the prevention and treatment of NEC.