Preventing Necrotizing Enterocolitis: Strategies for Disease Prevention

Introduction:

Premature babies (babies born between 25 weeks to 37 weeks of pregnancy) are prone to various infections and diseases soon after birth. Earlier the birth, the more complications. It may happen due to many factors; one main factor is underdeveloped immunity (ability to fight infections). Necrotizing enterocolitis is one such disease that affects premature babies soon after birth (within two to four weeks).

What Is Necrotizing Enterocolitis Disease?

Necrotizing enterocolitis is a disease that affects the intestine (small or large intestine), causing inflammation (enterocolitis) of the lining, which eventually causes the tissue cells to die (necrotize), which may give rise to perforations (holes) on the intestinal walls, leaking bacteria and other microorganisms into the bloodstream or abdomen (stomach, liver, spleen, intestines, gallbladder, kidney and reproductive organs).

What Causes Necrotizing Enterocolitis Disease?

The actual cause behind the disease is not yet known. Multiple factors play a role in the development of this disease. Some are as follows:

• Insufficient Blood and Oxygen Supply - Premature babies have underdeveloped lungs and tender hearts which may cause inadequate oxygen and blood supply that may cause the intestinal tissues to necrose (die).

• Formula Milk - Formula milk lacks essential antibodies, immune cells, and growth factors, making them vulnerable to infections and subsequent tissue necrosis.

• Underdeveloped Digestive System - In such cases, the body may be unable to filter the waste products effectively, causing toxins to build up and leading to infections and necrosis of the intestinal lining.

• Underdeveloped Intestinal Lining - The intestinal lining has a barrier that enables the absorption of nutrients while restricting that for microorganisms (bacteria). When this barrier development is incomplete (baby born before 26 weeks), bacteria can easily pass through into the abdomen and cause infections.

• Exposure to Bacterial Infection - An underdeveloped immune system fails to fight a severe bacterial infection (for example, sepsis) that may cause tissue necrosis.

• Blood Transfusion - Necrotizing enterocolitis is seen in some babies who need a blood transfusion in case of inadequate red blood cells (severe anemia).

Children born full term (after 37 weeks of pregnancy) may also be at risk for necrotizing enterocolitis when born with low birth weight, heart defects, lung defects, or other conditions that may affect the blood and oxygen supply to the intestine.

What Are the Symptoms of Necrotizing Enterocolitis Disease?

Symptoms vary for premature babies depending on how early one was born. Symptoms are usually seen from 2 to 3 weeks of birth and may be sudden in onset or progress through a few days. Signs and symptoms are as follows:

• Swelling of the stomach area (abdominal distension) that is painful to touch (tender).

• Red-blue discoloration of the distended abdomen.

• Unstable body temperature.

• Refuse feeding.

• Diarrhea with the presence of blood.

• Vomiting may be green or yellow due to the presence of bile (a fluid that helps in digestion).

• Low heart rate, blood pressure, and breathing rate.

What Is the Treatment for Necrotizing Enterocolitis Disease?

Treatment modalities depend on the severity, the age of the baby, the general health of the baby, and the symptoms of the disease.

• Stop feeding to keep the stomach and intestines empty.

• A nasogastric or orogastric tube (a tube running from the nose or mouth to the stomach) is inserted to keep the stomach empty.

• Food, nutrition, and medications to treat infections are given intravenously (IV- through veins).

• The baby may be kept in isolation to prevent further exposure to infections.

• The swollen abdomen may interfere with the baby's breathing, so an additional oxygen supply is given.

• Heart rate, blood pressure, and fluctuating temperatures are closely monitored.

• Surgery - Indicated if the baby has adequate weight and health to withstand surgery and healing.

  • Repair the perforation (hole) in the intestine.

  • Colostomy- a surgical procedure that takes part of the intestine into an opening (done by the surgeon) in the abdomen to help stool exit into a bag. After 6 to 8 weeks, the opening is closed once the intestine and the baby are healthy.,

  • Ileostomy- a surgical procedure to remove a part of the intestinal tissue (that cannot be repaired).

How to Prevent Necrotizing Enterocolitis Disease?

Preventive measures are based on the possible causative factors that may develop necrotizing enterocolitis in babies.

1. Antenatal Corticosteroids - Corticosteroid (a drug that helps reduce inflammation) therapy for women at risk of preterm labor (baby born before 36 weeks) with two doses within seven days has been shown to reduce the risk of developing necrotizing enterocolitis by various studies.

2. Breastmilk - The benefits of breast milk have been known for generations. Feeding the baby post-delivery, especially a premature baby, is necessary for immune cells, growth hormones, antibodies, nutrients, and more. The best source for these is- breast milk. Breast milk is also easily digestible and has less pH (not acidic), which can prevent the build-up of harmful bacteria, thereby preventing the risk of developing necrotizing enterocolitis.

3. Pasteurized Milk From a Human Donor - In case of insufficient breastmilk to feed the premature baby, pasteurized (especially processed) milk from another human (available in milk banks of hospitals) has advantages over formula milk and can prevent the risk of developing necrotizing enterocolitis.

4. Probiotics - These are a mixture of microorganisms with many benefits essential for gut (intestine and stomach) health. Studies have shown that when multiple strains of probiotics are given orally to premature babies, it helps prevent necrotizing enterocolitis. However, this treatment's exact dosage and duration are still being evaluated.

5. Restricted Use of Empirical Antibiotics - Empirical antibiotic therapy is treating with antibiotics with the assumption that infection may occur. Studies have shown that prolonged use of this therapy increases the risk of necrotizing enterocolitis and should be used when necessary for the infant's survival.

6. Standardized Feeding Protocol - This protocol suggests feeding premature babies within twenty-four hours of birth with breast milk fortified with calcium, phosphorus, and vitamin D. It also suggests the use of trophic feeding (feeding a small quantity at a time through a tube connected directly to the stomach or small intestine) for five days and later increase the quantity daily by 10 to 20 mL/kg per day if the baby is responding well. Studies have shown that a slow and consistent feeding pattern can reduce the risk of necrotizing enterocolitis.

7. Follow-Up - Premature babies must be closely monitored. Detecting early signs of abdomen distension can prevent the worsening of necrotizing enterocolitis.

Conclusion:

Necrotizing enterocolitis is a painful condition for premature babies. However, with recent studies showing promise through various methods to prevent necrotizing enterocolitis, it is all about timely intervention.