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Necrotizing Enterocolitis

  • Stephanie C. PapillonEmail author
  • Scott S. Short
  • Henri R. Ford
Reference work entry

Abstract

Necrotizing enterocolitis (NEC) is the predominant intestinal inflammatory disorder affecting the newborn infant. Risk factors for NEC include prematurity, formula feeding, and bacterial colonization of the gastrointestinal (GI) tract. The number of neonates at risk of developing NEC continues to rise due to recent advances in neonatology that have resulted in increased survival of extremely premature infants. Clinical features of NEC are often nonspecific and include evidence of physiologic instability, feeding intolerance, abdominal distention, and hematochezia. A cluster of key clinical and radiographic findings, known as the Bell staging system, has been used to characterize disease severity. Despite aggressive management strategies, morbidity and mortality from NEC remain high. Thus, this vexing disease will likely remain a major contributor to healthcare costs and may, one day, become the leading cause of death among premature infants. Optimal preventive strategies are needed to avert the devastating consequences of NEC.

Keywords

Necrotizing enterocolitis Short bowel syndrome Ostomy, prematurity Low birth weight infants Peritoneal drainage Total parenteral nutrition 

References

  1. Afrazi A, Sodhi CP, Richardson W, Neal M, Good M, Siggers R, et al. New insights into the pathogenesis and treatment of necrotizing enterocolitis: toll-like receptors and beyond. Pediatr Res. 2011;63(9):183–8.CrossRefGoogle Scholar
  2. Ahle M, Drott P, Andersson RE. Epidemiology and trends of necrotizing enterocolitis in Sweden: 1987–2009. Pediatrics. 2013;132(2):e443–51.PubMedCrossRefGoogle Scholar
  3. AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev. 2014;10(4):CD005496. https://www.ncbi.nlm.nih.gov/pubmed/24723255Google Scholar
  4. Amoury RA. Necrotizing enterocolitis following repair of gastroschisis. J Pediatr Surg. 1989;24(5):513–4.PubMedCrossRefGoogle Scholar
  5. Ballance WA, Dahms BB, Shenker N, Kleigman RM. Pathology of neonatal necrotizing enterocolitis: a ten-year experience. J Pediatr. 1990;117(1 Pt 2):S6–13.PubMedCrossRefGoogle Scholar
  6. Bauer CM, Morrsion JC, Poole WK, Korones SB, Boehm JJ, Rigatto H, et al. A decreased incidence of necrotizing enterocolitis after prenatal glucocorticoid therapy. Pediatrics. 1984;73(5):682–8.PubMedGoogle Scholar
  7. Blakely ML, Lally KP, McDonald S, Brown RL, Barnhart DC, Ricketts RR, et al. Postoperative outcomes of extremely low birth-weight infants with necrotizing enterocolitis or isolated intestinal perforation: a prospective cohort study by the NICHD Neonatal Research Network. Ann Surg. 2005;241(6):984–9.PubMedPubMedCentralCrossRefGoogle Scholar
  8. Christensen RD, Gordon PV, Besner GE. Can we cut the incidence of necrotizing enterocolitis in half–today? Fetal Pediatr Pathol. 2010;29(4):185–98.PubMedCrossRefGoogle Scholar
  9. Dominguez KM, Moss RL. Necrotizing enterocolitis. In: Holcomb III GW, Murphy J, Ostlie DJ, editors. Ashcraft’s pediatric surgery. 6th ed. Philadelphia: Saunders; 2014. p. 454–73.Google Scholar
  10. Duro D, Kalish LA, Johnston P, Jaksic T, McCarthy M, Martin C, et al. Risk factors of intestinal failure in infants with necrotizing enterocolitis: a Glaser Pediatric Research Network study. J Pediatr. 2010;157(2):203–8.PubMedPubMedCentralCrossRefGoogle Scholar
  11. Ford HR. Mechanism of nitric oxide-mediated intestinal barrier failure: insight into the pathogenesis of necrotizing enterocolitis. J Pediatr Surg. 2006;41(2):294–9.PubMedCrossRefGoogle Scholar
  12. Ganapathy V, Hay JW, Kim JH, Lee ML, Rechtman DJ. Long term healthcare costs of infants who survived neonatal necrotizing enterocolitis: a retrospective longitudinal study among infants enrolled in Texas Medicaid. BMC Pediatr. 2013;20:13–127.Google Scholar
  13. Gould SJ. The pathology of necrotizing enterocolitis. Semin Fetal Neonatal Med. 1997;2(4):239–44.CrossRefGoogle Scholar
  14. Goulet O, Ruemmele F. Causes and management of intestinal failure in children. Gastroenterology. 2006;130(2):S16–28.PubMedCrossRefGoogle Scholar
  15. Guthrie SO, Gordon PV, Thomas V, Thorp JA, Peabody J, Clark RH. Necrotizing enterocolitis among neonates in the United States. J Perinatol. 2003;23(4):278–85.PubMedCrossRefGoogle Scholar
  16. Hackam DJ, Grikscheit T, Wang K, Upperman JS, Ford HR. Pediatric surgery. In: Brunicardi FC, Anderson DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, et al., editors. Schwartz’s principles of surgery. 10th ed. New York: McGraw Hill; 2015.Google Scholar
  17. Halac E, Halac J, Begue EF, Casanas JM, Indiveri DR, Petit JF, et al. Prenatal and postnatal corticosteroid therapy to prevent necrotizing enterocolitis: a controlled trial. J Pediatr. 1990;117(1 pt 1):132–8.PubMedCrossRefGoogle Scholar
  18. Hansen ML, Juhl SM, Fonnest G, Greisen G. Surgical findings during exploratory laparotomy are closely related to mortality in premature infants with necrotising enterocolitis. (Oslo, 1992). Acta Paediatr. 2016. [Epub ahead of print]. https://www.ncbi.nlm.nih.gov/pubmed/27935107
  19. Heida FH, Stolwijk L, Loos MH, et al. Increased incidence of necrotizing enterocolitis in the Netherlands after implementation of the new Dutch guideline for active treatment in extremely preterm infants: results from three academic referral centers. J Pediatr Surg. 2017;52(2):273–6. https://www.ncbi.nlm.nih.gov/pubmed/27923478PubMedCrossRefGoogle Scholar
  20. Hintz SR, Kendrick DE, Stoll BJ, Vohr BR, Fanaroff AA, Donovan EF, et al. Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis. Pediatrics. 2005;115(3):696–703.CrossRefGoogle Scholar
  21. Holman RC, Stoll BJ, Curns AT, Yorita KL, Steiner CA, Schonberger LB. Necrotising enterocolitis hospitalisations among neonates in the United States. Paediatr Perinat Epidemiol. 2006;20(6):498–506.PubMedCrossRefGoogle Scholar
  22. Horwitz JR, Lally KP, Cheu HW, Vazquez WD, Grosfeld JL, Ziegler MM. Complications after surgical interventions for necrotizing enterocolitis: a multicenter review. J Pediatr Surg. 1995;30(7):994–8.PubMedCrossRefGoogle Scholar
  23. Hunter CJ, Podd B, Ford HR, Camerini V. Evidence vs. experience in neonatal practices in necrotizing enterocolitis. J Perinatol. 2008;28(Suppl 1):S9–S13.PubMedCrossRefGoogle Scholar
  24. Israel EJ, Schiffirn EJ, Carter EA, Freiberg E, Walker WA. Prevention of necrotizing enterocolitis in the rat with prenatal cortisone. Gastroenterology. 1990;99(5):1333–8.PubMedCrossRefGoogle Scholar
  25. Jayanthi S, Seymour P, Puntis JW, Stringer MD. Necrotizing enterocolitis after gastroschisis repair: a preventable complication? J Pediatr Surg. 1998;33(5):705–7.PubMedCrossRefGoogle Scholar
  26. Leflore JL, Salhab WA, Broyles RS, Engle WD. Association of antenatal and postnatal dexamethasone exposure with outcomes in extremely low birth weight neonates. Pediatrics. 2002;110(2 Pt 1):275–9.PubMedCrossRefGoogle Scholar
  27. Llanos AR, Moss ME, Pinzon MC, Dye T, Sinkin RA, Kendig JW. Epidemiology of neonatal necrotising enterocolitis: a population-bases study. Paediatr Perinat Epidemiol. 2002;16(4):342–9.PubMedCrossRefGoogle Scholar
  28. Mizrahi A, Barlow O, Berdon W, Blanc WA, Silvermon WA. Necrotizing enterocolitis in premature infants. J Pediatr. 1965;66(4):697–706.PubMedCrossRefGoogle Scholar
  29. Mollitt DL, Golladay ES. Postoperative neonatal necrotizing enterocolitis. J Pediatr Surg. 1982;17(6):757–63.PubMedCrossRefGoogle Scholar
  30. Moore TC. Successful use of the “patch, drain and wait” laparotomy approach to perforated necrotizing enterocolitis: is hypoxia-triggered “good angiogenesis” involved? Pediatr Surg Int. 2000;16(5–6):356–63.PubMedCrossRefGoogle Scholar
  31. Moss RL, Dimmitt RA, Barnhart DC, Sylvester KG, Brown RL, Powell DM, et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med. 2006;354(21):2225–34.CrossRefGoogle Scholar
  32. Nadler EP, Dickinson E, Knisely A, Zhang XR, Boyle P, Beer-Stolz D, et al. Expression of inducible nitric oxide synthase and interleukin-12 in experimental necrotizing enterocolitis. J Surg Res. 2000;92:71–7.PubMedCrossRefGoogle Scholar
  33. Nadler EP, Upperman JS, Ford HR. Controversies in the management of necrotizing enterocolitis. Surg Infect. 2001;2(2):113–9.CrossRefGoogle Scholar
  34. Neu J, Pammi M. Pathogenesis of NEC: impact of an altered intestinal microbiome. Semin Perinatol. 2017;41(1) 29–35.PubMedCrossRefGoogle Scholar
  35. Niño DF, Sodhi CP, Hackam DJ. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Nat Rev Gastroenterol Hepatol. 2016;13(10):590–600. https://www.ncbi.nlm.nih.gov/pubmed/27534694PubMedPubMedCentralCrossRefGoogle Scholar
  36. Oldham KT, Coran AG, Drongowski RA, Baker PJ, Wesley JR, Polley Jr TZ. The development of necrotizing enterocolitis following repair of gastroschisis: a surprisingly high incidence. J Pediatr Surg. 1988;23(10):945–9.PubMedCrossRefGoogle Scholar
  37. Ostlie DJ, Spilde TL, St Peter SD, Sexton N, Miller KA, Sharp RJ, et al. Necrotizing enterocolitis in full-term infants. J Pediatr Surg. 2003;38(7):1039–42.PubMedCrossRefGoogle Scholar
  38. Patel RM, Knezevic A, Shenvi N, et al. Association of red blood cell transfusion, anemia, and necrotizing enterocolitis in very low-birth-weight infants. JAMA. 2016;315(9):889–97. https://www.ncbi.nlm.nih.gov/pubmed/26934258PubMedPubMedCentralCrossRefGoogle Scholar
  39. Pierro A. The surgical management of necrotizing enterocolitis. Early Hum Dev. 2005;81(1):79–85.PubMedCrossRefGoogle Scholar
  40. Pike K, Brocklehurst P, Jones D, Kenyon S, Salt A, Taylor D, et al. Outcomes at 7 years for babies who developed neonatal necrotising enterocolitis: the ORACLE Children Study. Arch Dis Chil Fetal Neonatal Ed. 2012;97(5):F318–22.CrossRefGoogle Scholar
  41. Rees CM, Eaton S, Kiely EM, Wade AM, McHugh K, Pierro A. Peritoneal drainage or laparotomy for neonatal bowel perforation? A randomized controlled trial. Ann Surg. 2008;248(1):44–51.PubMedCrossRefGoogle Scholar
  42. Sankaran K, Puckett B, Lee DS, Seshia M, Boulton J, Qiu Z, et al. Variations in incidence of necrotizing enterocolitis in Canadian neonatal intensive care units. J Pediatr Gastroenterol Nutr. 2004;39(4):366–72.PubMedCrossRefGoogle Scholar
  43. Santulli TV, Schullinger JN, Heird WC, Gongaware RD, Wigger J, Barlow B, et al. Acute necrotizing enterocolitis in infancy: a review of 64 cases. Pediatrics. 1975;55(3):376–87.PubMedGoogle Scholar
  44. Sato TT, Oldham KT. Pediatric abdomen. In: Mulholland MW, Lillemoe KD, Doherty GM, Maier RV, Simeone DM, Upchurch GR, editors. Greenfield’s surgery scientific principles and practice. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2011.Google Scholar
  45. Schlager A, Arnold M, Moore SW, Nadler EP. Necrotizing enterocolitis. In: Ameh EA, Bickler SW, Lakhoo K, Nwomeh BC, Poenaru D, editors. Pediatric surgery: a comprehensive text for Africa. Seattle: Global Help Organization; 2012. p. 416–23.Google Scholar
  46. Sodhi CP, Shi XH, Richardson WM, Grant ZS, Shapiro RA, Prindle Jr T, et al. Toll-like receptor-4 inhibits enterocyte proliferation via impaired beta-catenin signaling in necrotizing enterocolitis. Gastroenterology. 2010;138(1):185–96.PubMedCrossRefGoogle Scholar
  47. Soliman A, Michelson KS, Karahashi H, Lu J, Meng FJ, Qu X, et al. Platelet-activating factor induces TLR4 expression in intestinal epithelial cells: implication for the pathogenesis of necrotizing enterocolitis. PLoS One. 2010;5(10):e15044.PubMedPubMedCentralCrossRefGoogle Scholar
  48. Sylvester KG, Liu GY, Albanese CT. Necrotizing enterocolitis. In: Coran AG, Adzick NS, Krummel TM, Laberge JM, Shamberger RC, Caldamone AA, editors. Pediatric surgery. 7th ed. Philadelphia: Mosby; 2012. p. 1187–207.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  • Stephanie C. Papillon
    • 1
    Email author
  • Scott S. Short
    • 1
  • Henri R. Ford
    • 1
  1. 1.Division of Pediatric SurgeryChildren’s Hospital Los AngelesLos AngelesUSA

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