Necrotizing Enterocolitis: Refocusing Efforts on Prevention

Necrotizing enterocolitis (NEC), a gastrointestinal inflammatory disorder, is one of the most serious diseases affecting preterm, very low birth weight infants and requires emergency medical and/or surgical intervention in the Neonatal Intensive Care Unit (NICU) [1,2]. The symptoms of NEC include abdominal distension, bilious vomiting, bloody stools after 8-10 days of life and may proceed towards septic shock, disseminated intravascular coagulation, peritonitis and intestinal perforation [3,4]. Even though the exact etiology and pathogenesis are incompletely understood, research suggests a multifactorial basis. Suspected risk factors include genetic predisposition, intestinal immaturity, highly immunoreactive intestinal mucosa, prematurity, enteral feeding, and altered bacterial colonization of intestine resulting in immune activation followed by intestinal barrier failure [4-7]. NEC affects are exclusively postpartum even though the fetus has undergone stress and fetal ingestion of 150 ml/kg per day of amniotic fluid containing proteins, carbohydrates, fat, immunoglobulins, and electrolytes [5].