Necrotizing enteritis (NEC)

Yarden Levin Shikartz

When a newborn is born before 37 weeks (premature), not all of the body's systems are developed properly, which can lead to long-term consequences. Immaturity of the digestive system can lead to necrotizing enteritis (NEC).

 Why is this happening?

The actual cause of necrotizing enteritis is unknown, but the immaturity of the digestive system is at the center. This immaturity is manifested by insufficiently developed intestines, poor secretion of gastric juices and digestive enzymes. Also, the intestinal mucosa can, under inflammatory conditions, lead to its erosion.^[4]The earlier the week of birth, the greater the immaturity of the digestive system and therefore, the greater the chance of necrotizing enteritis.

 What's going on?

The symptoms of necrotizing enteritis, which usually appear about 8-10 days after birth, include a swollen abdomen, bloody stools, and difficulty eating. These symptoms can occur in varying degrees of severity, depending on the degree of inflammation.^[6].

 prevention

Prevention of necrotizing enteritis is based primarily on preserving the good bacteria in the digestive system, with the help of:

• nursing  Breast milk has special properties that protect the digestive system. Breast milk also encourages the growth of friendly bacteria.^{[7][3][5][6][2][1]}.
• Probiotics  There are many studies that indicate the use of probiotics, which contain friendly bacteria, as reducing the rate and severity of necrotizing fasciitis and preventing its occurrence.^{[7][3][5][6][2][1]}.

Sources

1. Campos-Martinez, AM, Expósito-Herrera, J., Gonzalez-Bolívar, M., Fernández-Marin, E., & Uberos, J. (2022). Evaluation of risk and preventive factors for necrotizing enterocolitis in premature newborns. A systematic review of the literature. Frontiers in Pediatrics, 10.
2. Colarelli, AM, Barbian, ME, & Denning, PW (2024). Prevention Strategies and Management of Necrotizing Enterocolitis. Current Treatment Options in Pediatrics, 10, 126–146.
3. Hall, NJ, Eaton, S., & Pierro, A. (2013). Necrotizing enterocolitis: Prevention, treatment, and outcome. Journal of Pediatric Surgery, 48(12), 2359–2367.
4. Hu, X., Liang, H., Li, F., Zhang, R., Zhu, Y., Zhu, X., & Xu, Y. (2024). Necrotizing enterocolitis: Current understanding of the prevention and management. Pediatric Surgery International, 40(1).
5. Hunter, CJ, Upperman, JS, Ford, HR, & Camerini, V. (2008). Understanding the susceptibility of the premature infant to necrotizing enterocolitis (NEC). Pediatric Research, 63(2), 117–123.
6. Jin, Y.-T., Duan, Y., Deng, X.-K., & Lin, J. (2019). Prevention of necrotizing enterocolitis in premature infants - an updated review. World Journal of Clinical Pediatrics, 8(2), 23–32.
7. Krasan, G. (2006). Oral probiotics prevent necrotizing enterocolitis in very low birth weight neonates. Yearbook of Neonatal and Perinatal Medicine, 2024, 224–226.