Necrotizing Enterocoliltis:Is Care Getting Better?

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Necrotizing enterocolitis (NEC) is a devastating intestinal condition typically associated with premature infants in neonatal intensive care units (NICUs). NEC is associated with both a high mortality rate as well as a high rate of neurodevelopmental disability (NDD).

As survival of premature infants increases, the risk of NEC also has increased, and the authors of this study looked at current outcomes of NEC in the medical literature. In particular, a review of the literature occurred using the PRISMA Statement (http:// PRISMAStatement). PubMed also was searched for the following terms: “NEC,” “mortality,” “morbidity,” “neurodevelopmental outcome,” “outcomes”, and “intestinal failure.” Included articles had to be in English and had to be published after January 2010 with reported NEC outcomes (mortality) from international/national/regional/multi-center studies from high-income countries.

Initially, 1371 articles were included, but only 31 articles met the criteria of studying mortality that could be included in a meta-analysis. Mortality from NEC (Bell stage 2A or higher) was 23.5% (95% confidence interval 18.5% to 28.8%) with low birthweight and history of NEC surgery being risk factors. In particular, the mortality of infants less than 1000 grams who underwent surgery for NEC was 50.9% (95% confidence interval 38.1% to 63.5%). The meta-analysis demonstrated that mortality from NEC in premature infants ranged from 10% to 21%. Five studies meeting criteria for evaluating NDD in the setting of NEC, and severe NDD ranged between 24.8% and 59.5% although the definition of “severe” varied between studies. Finally, only three studies described the association between intestinal failure (defined as intestine loss preventing normal intestinal absorption and growth) and NEC with intestinal failure rates of 15.2% in all infants with NEC and 35.4% in infants with NEC requiring surgery.

This meta-analysis provides convincing evidence that NEC still is extremely problematic in NICUs, and further research is necessary to decrease associated morbidity and mortality. Further research should be aimed towards understanding potential associated genetic mechanisms involved in NEC as well as considering the possibility of new types of pre-/pro-/ symbiotic strains to reduce the complications of this devastating disease.

Jones I. and Hall N. Contemporary outcomes for infants with necrotizing enterocolitis – a systemic review. Journal of Pediatrics 2020; 220: 86-92.

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