NEONATAL NECROTIZING ENTEROCOLITIS - DIAGNOSTIC PROBLEMS

Abstract

Necrotizing enterocolitis (NEC) is a life-threatening intestinal disease characterized by severe intestinal inflammation and necrosis.It is mostly seen in very premature infants (≤32 weeks of gestation). Despite the efforts of recent years toward garnering a better understanding of this disease as well as its eradication, but it has persisted and is now one of the leading causes of mortality and morbidity in neonatal intensive care units.In the last decades the reported incidence of preterm necrotizing enterocolitis (NEC) has been declining in large part due to implementing comprehensive NEC prevention initiatives, including breast milk feeding, standardized feeding protocols, transfusion guidelines, and antibiotic stewardship and improving the rigor with which non-NEC cases are excluded.For improvements in therapies to allow preterm infants to survive, it is crucial to ensure accurate reporting of the diagnosis and gain improved insight into the true incidence of this very challenging disease.There are several reasons for this lack of progress in understanding of this disease. There is a lack of a common, comprehensive definition of NEC. There is a poor definition of what actually constitutes “NEC.” In fact, this entity probably represents several different diseases with different pathophysiologic pathways.The purpose of this review is to consider a current definition of NEC, and define adequate biomarkers which may be used to help guide clinical decision-making. Diagnostic criteria should include specific, sensitive, and accurate clinical and laboratory criteria that aid the clinician in recognizing the most classic form of this disease and differentiating it from entities such as spontaneous intestinal perforation, primary intestinal ischemia, sepsis, food protein intolerance, and others