by What is Necrotizing Enterocolitis?
Necrotising enterocolitis (NEC) is a devastating illness that primarily affects very premature infants. It is characterized by inflammation and bacterial infection of the intestine. The pathogenesis is thought to involve disturbances to the normal bacterial colonization of the gut in preterm infants, combined with an immature immune system that has trouble fighting off infection. NEC results in tissue death of areas of the intestine (necrosis). Symptoms can range from mild to very severe, depending on how much of the intestine is affected.
Risk Factors and Causes
Premature birth is the leading risk factor for developing Necrotising enterocolitis (NEC). Infants born before 32 weeks gestation or with very low birth weight are most susceptible. The immature intestinal immune system and altered intestinal bacteria put these infants at high risk. Other potential risk factors include formula feeding instead of breastmilk, bacterial or viral infections, genetic abnormalities, and certain medical interventions like intravenous lines that are used more often in extremely premature babies. The exact causes are not fully known but it is believed NEC arises from an excessive inflammatory response to bacterial colonization in the immature intestine.
Symptoms
Symptoms of NEC may develop gradually over time or come on suddenly and aggressively. Common signs include abdominal distention, vomiting, diarrhea, blood in the stool, and difficulty passing stool. The infant may experience temperature instability, appear lethargic, and have slower than normal heart and breathing rates. As NEC progresses and the intestine becomes more damaged, symptoms worsen and the infant may experience life-threatening complications like intestinal perforation.
Diagnosis and Stages
Diagnosis of NEC involves a physical exam and abdominal x-rays to check for signs of intestinal injury and inflammation. The disease is classified into stages based on severity of symptoms and test results. Stage I NEC involves subtle changes to the intestine visible on imaging but no definite signs of necrosis. Stage II reflects more severe involvement with evidence of intestinal pneumatosis (gases in the intestinal wall). Stage III is the most advanced stage where there is evidence of abscesses, perforation, or poor clinical progression despite treatment. Staging helps determine appropriate treatment and risks for complications.
Treatment and Prognosis
Treatment for NEC depends on the stage and extent of disease. Stage I and mild Stage II cases may respond to withholding feeding and treating with antibiotics or intravenous immunoglobulin therapy. More severe or worsening cases require surgery. The intestine may need to be partially or fully removed (resection) if large areas have died. Drainage of any intestinal perforations or abscesses is often performed. Despite aggressive medical and surgical treatment, NEC carries risks for serious complications or death, especially in extremely premature infants. Prognosis depends on the degree of intestinal involvement at diagnosis as well as the infant’s overall health status and ability to recover from surgery if needed. With advances in neonatal care, survival rates have increased but NEC continues to be one of the most severe gastrointestinal emergencies in newborns.
Long Term Necrotizing Enterocolitis
For infants who survive NEC, follow up is important to monitor for potential ongoing issues. Short bowel syndrome, a condition where too little healthy intestine remains after extensive surgery, may lead to malnutrition, dehydration and need for parenteral nutrition support. Other sequelae can include delayed motor development due to manipulation of the intestine during surgery. Chronic lung disease in preterm infants is also seen more often in babies who had NEC. Intestinal strictures are scar-like narrowings that may require further surgeries down the road. Infants are typically followed by a team of specialists after discharge to optimize nutrition, growth, and monitor for any other delays. With multidisciplinary care, many children can achieve normal development despite having a history of serious NEC in the newborn period.
In Summary, given the substantial risks associated with developing NEC, efforts are focused on prevention. The leading protective strategy is promoting and supporting breastmilk feeding for preterm infants – human milk feeds have been shown to significantly lower NEC risk compared to formula. Other preventative measures include probiotic supplementation which provides beneficial gut bacteria, minimizing use of sedatives and analgesics that may impair intestinal motility, and carefully monitoring feed advancement rates to avoid overfeeding of premature infants. Continued research into probiotic strains, prebiotics, donor breastmilk, and targeted therapies holds promise for refining prevention strategies and reducing the burden of NEC.
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1.Source: Coherent Market Insights, Public sources, Desk research
2.We have leveraged AI tools to mine information and compile it
Money Singh is a seasoned content writer with over four years of experience in the market research sector. Her expertise spans various industries, including food and beverages, biotechnology, chemical and materials, defense and aerospace, consumer goods, etc.
