Enteral Feeding Interventions in the Prevention of Necrotizing Enterocolitis: A Systematic Review of Experimental and Clinical Studies.

Ilse H De Lange,Wim G Van Gemert,Joep P M Derikx,Tim G A M Wolfs,Laurens D Eeftinck Schattenkerk,Charlotte Van Gorp

doi:10.3390/nu13051726

Abstract

Necrotizing enterocolitis (NEC), which is characterized by severe intestinal inflammation and in advanced stages necrosis, is a gastrointestinal emergency in the neonate with high mortality and morbidity. Despite advancing medical care, effective prevention strategies remain sparse. Factors contributing to the complex pathogenesis of NEC include immaturity of the intestinal immune defense, barrier function, motility and local circulatory regulation and abnormal microbial colonization. Interestingly, enteral feeding is regarded as an important modifiable factor influencing NEC pathogenesis. Moreover, breast milk, which forms the currently most effective prevention strategy, contains many bioactive components that are known to support neonatal immune development and promote healthy gut colonization. This systematic review describes the effect of different enteral feeding interventions on the prevention of NEC incidence and severity and the effect on pathophysiological mechanisms of NEC, in both experimental NEC models and clinical NEC. Besides, pathophysiological mechanisms involved in human NEC development are briefly described to give context for the findings of altered pathophysiological mechanisms of NEC by enteral feeding interventions.

Highlights

Necrotizing enterocolitis (NEC) is a multifactorial disease, characterized by severe intestinal inflammation and, in advancing disease, gut necrosis, that mainly affects premature neonates [1]
General search terms for nutritional interventions as well as terms for specific nutritional interventions often used in the context of NEC (alkaline phosphatase (ALPI), epidermal growth factor (EGF)/heparinbinding EGF-like growth factor (HB-EGF), erythropoietin (EPO), exosomes, gangliosides, glutamine, immunoglobulins, insulin like growth factor (IGF), milk fat globule membrane, oligosaccharides, osteopontin, platelet-activating factor acetylhydrolase (PAF-AH), polyunsaturated fatty acids (PUFA), transforming growth factor β (TGF β), vitamin A and vitamin D) were incorporated in the search
We identified a total number of 5883 records

Summary

Introduction

Necrotizing enterocolitis (NEC) is a multifactorial disease, characterized by severe intestinal inflammation and, in advancing disease, gut necrosis, that mainly affects premature neonates [1]. Around 5 to 10% of very low birth weight (VLBW) infants develop NEC, with the highest incidence among neonates with an extremely low birth weight (ELBW) [2]. NEC incidence has not substantially decreased over time, mainly due to increased early survival of neonates [3,4,5]. Infants that do recover from NEC suffer from several long-term morbidities such as growth retardation [9], short bowel syndrome [10], intestinal failure [11], intestinal failure-associated liver disease and neurodevelopmental delays [12]. Life-long care for patients with morbidities following NEC will impose an even higher financial burden on both society and the individual patient [15]. NEC forms an important health issue that has high impact on the patient and its parents and leads to a significant economic burden

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Conclusion