Pathophysiology
The following factors are implicated in the pathogenesis of NEC [1]:
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Although the pathogenesis of NEC remains unknown, research suggests it is a multifactorial disease that results in a gastrointestinal (GI) mucosal injury in a susceptible host.
Specific findings vary and are highly dependent on the disease progression and the presence of underlying pathogenic factors. The majority of cases involve an intestinal infarction often in the terminal ileum and colon, while severe cases affect the entire GI tract [1]. |
A current pathophysiological model of NEC proposes that a mucosal injury in the preterm intestine results in the translocation of luminal bacteria across the epithelial barrier, triggering an exaggerated local inflammatory response. Infants of extremely low birth weight (<1000 g) or with advanced cases of NEC, may present with total gut necrosis termed 'NEC totalis'. These lesions are characterized by coagulation necrosis, bacterial overgrowth, pneumatosis intestinalis, and inflammation. [2].
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Incidence
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- Similar figures (7.4 %) have been reported by the Vermont Oxford Network, which included data from 71,808 very low birth weight (VLBW, <1500 g) infants from 2005 to 2006 [6].
- Studies from Europe show lower incidence, ranging between 3 and 5.8% [7,8].
- In the United States, multicentric studies from the Neonatal Research Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development have reported the incidence of NEC as 7–11% [3-5].
Prognosis
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References
- Schanler, R.J. (2016). Clinical features and diagnosis of necrotizing enterocolitis in newborns. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on May 6, 2016).
- Maheshwari, A. & Kasivajjula, H. (2014). Pathophysiology and current management of necrotizing enterocolitis. The Indian Journal of Paediatrics, 81 (5), 489-497.
- Yee, W. H., Soraisham, A. S,, Shah, V. S,, Aziz, K,, Yoon, W,, Lee, S. K., & Canadian Neonatal Network. (2012). Incidence and timing of presentation of necrotizing enterocolitis in preterm infants. Pediatrics, 129, e298–304.
- Fanaroff, A. A,, Stoll, B. J,, Wright, L. L,., Carlo, W. A,, Ehrenkranz, R. A,, Stark, A. R,, ... NICHD Neonatal Research Network. (2007). Trends in neonatal morbidity and mortality for very low birthweight infants. American Journal of Obstetrics and Gynecology, 196(2), 147.e1-147.e8.
- Stoll, B. J. (1994). Epidemiology of necrotizing enterocolitis. Clinical Perinatology, 21, 205–218.
- Stoll, B. J,, Hansen, N. I,, Bell, E. F,, Shankaran, S,, Laptook, A. R,, Walsh, M. C,, ... Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. (2010). Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics, 126(3), 443–456.
- Fitzgibbons, S. C,, Ching, Y., Yu, D,, Carpenter, J,, Kenny, M,, Weldon, C., ... Jaksic, T. (2009). Mortality of necrotizing enterocolitis expressed by birth weight categories. Journal of Pediatric Surgery, 44(6), 1072–1075.
- EXPRESS Group. (2010). Incidence of and risk factors for neonatal morbidity after active perinatal care: Extremely preterm infants study in Sweden (EXPRESS). Acta Paediatrica, 99, 978–992.
- Bajwa, N. M,, Berner, M,, Worley, S,, Pfister, R. E., & Swiss Neonatal Network. (2011). Population based age stratified morbidities of premature infants in Switzerland. Swiss Med Weekly, 141:w13212
- Lin, P. W,, & Stoll, B. J. (2006). Necrotising enterocolitis. Lancet, 368, 1271–1283.
- Henry, M. C,, & Moss, R. L. (2009). Necrotizing enterocolitis. Annual Review of Medicine, 60, 111–124.
- Amin, S. C,, Pappas, C,, Iyengar, H,, & Maheshwari, A. (2013). Short bowel syndrome in the NICU. Clinical Perinatology, 40, 53–68.
- Kastenberg, Z. J,, & Sylvester, K. G. (2013). The surgical management of necrotizing enterocolitis. Clinical Perinatology. 40, 135–148.
- Hintz, S. R,, Kendrick, D. E,, Stoll, B. J,, Vohr, B. R,, Fanaroff, A. A,, Donovan, E. F,, ... NICHD Neonatal Research Network. (2005). Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis. Pediatrics, 115, 696–703.
- Pike, K,, Brocklehurst, P,, Jones, D,, Kenyon, S,, Salt, A,, Taylor, D,, & Marlow, N. (2012). Outcomes at 7 y for babies who developed neonatal necrotising enterocolitis: The ORACLE Children Study. Archives of Disease in Childhood, Fetal and Neonatal Edition, 97(5), F318–322.
- Schulzke, S. M., Deshpande, G. C., & Patole, S. K. (2007). Neurodevelopmental outcomes of very low-birth-weight infants with necrotizing enterocolitis - A systematic review of observational studies. JAMA Paediatrics, 161(6), 583-590.