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Hypoxic-ischemic enterocolitis: a proposal of a new terminology for early NEC or NEC-like disease in preterm infants, a single-center prospective observational study

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Abstract

We aimed to investigate the role of hypoxia-ischemia in the pathophysiology of early NEC/NEC like disease (ENEC) and classic NEC/NEC like disease (CNEC) in preterm infants. In this pilot study, preterm infants who developed the clinical symptoms and signs of NEC/NEC like disease were divided into two groups as early (≤ 7 days, ENEC) or late (> 7 days, CNEC) groups. Beside clinical variables, serum L-lactate, endothelin-1 (ET-1), platelet activating factor (PAF), and intestinal fatty acid binding protein (I-FABP) levels were measured from umbilical/peripheric venous blood in the first hour of life and during the clinical presentation in all groups. A total of 86 preterm infants were enrolled in the study. In the ENEC group, the incidences of fetal umbilical artery Doppler velocimetry abnormalities, IUGR, and delayed passage of first meconium were higher. In addition, mean levels of L-lactate, ET-1, PAF, and I-FABP were higher in the first hour of life.

Conclusion: Our study firstly showed that the dominant pathophysiological factor of ENEC is prenatal hypoxic-ischemic event where intestinal injury and inflammation begin in-utero and become clinically apparent in the first week of life. Therefore, we propose a new term “Hypoxic-Ischemic Enterocolitis (HIEnt)” for the definition of ENEC in preterm infants with prenatal hemodynamic disturbances and IUGR. This new sight can provide individualized preventive and therapeutic strategies for preterm infants.

What is Known:

• The pathophysiology of early necrotizing enterocolitis (NEC) or NEC-like disease which is seen in the first week of life seems different than classic necrotizing enterocolitis (CNEC) which is always seen after the first week of life.

What is New:

• This study suggests that perinatal hypoxic-ischemic process with inflammation is the point of origin of fetal intestinal injury leading to ENEC.

• We propose a new term “Hypoxic-Ischemic Enterocolitis (HIEnt)” for the definition and differentiation of this unique clinical entity.

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Abbreviations

AREDF:

absent or reversed end-diastolic blood flow

CNEC:

classic necrotizing enterocolitis

ENEC:

early necrotizing enterocolitis

ET-1:

endothelin-1

I-FABP:

intestinal fatty acid binding protein

IUGR:

intrauterine growth restriction

NEC:

necrotizing enterocolitis

NICU:

neonatal intensive care unit

PAF:

platelet activating factor

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Acknowledgment

We thank Professor Pinar Erkekoglu for performing ELISA analysis.

Funding

This study was supported by Hacettepe University (Research Grant No: 011 D04 101008)

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Authors and Affiliations

  1. Section of Neonatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Ozge Surmeli Onay, Ayse Korkmaz, Sule Yigit & Murat Yurdakok

Authors
  1. Ozge Surmeli Onay
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  2. Ayse Korkmaz
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  3. Sule Yigit
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  4. Murat Yurdakok
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Contributions

Dr. Surmeli Onay organized the data collection, carried out the initial analyses, drafted the initial manuscript.

Dr. Korkmaz conceptualized and designed the study, proposed the new terminology, controlled the analyses, drafted the first and final manuscripted as submitted.

Drs Yigit and Yurdakok reviewed the manuscript and approved the final manuscript as submitted.

Corresponding author

Correspondence to Ozge Surmeli Onay.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The Institutional Ethics Committee approved the study (No: HEK 10/91).

Informed consent

Informed consent forms were received from all parents before inclusion in the study.

Additional information

Communicated by Patrick Van Reempts

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Surmeli Onay, O., Korkmaz, A., Yigit, S. et al. Hypoxic-ischemic enterocolitis: a proposal of a new terminology for early NEC or NEC-like disease in preterm infants, a single-center prospective observational study. Eur J Pediatr 179, 561–570 (2020). https://doi.org/10.1007/s00431-019-03539-w

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  • DOI: https://doi.org/10.1007/s00431-019-03539-w

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