Predictors of Necrotizing Enterocolitis in LBW Infants

What Is Necrotizing Enterocolitis?

Necrotizing enterocolitis is a specific and grave ailment that primarily focuses on the gastrointestinal health of newlyborn babies. Babies within six weeks of age are more vulnerable to this intestinal infection. The incidence of necrotizing enterocolitis is low for babies born after attaining the intended growth in the mother’s womb. In contrast, the incidence is more pronounced in infants with compromised birth weight who are delivered prematurely before the estimated birth date.

Stomach discomfort, abdominal pain, green-colored vomit, puffy abdomen, blood streaks on the baby’s stool, diarrhea, the baby's reluctance to feed, absence of expected growth, and no appreciable weight gain post-birth are the frequently reported manifestations of necrotizing enterocolitis. Additional manifestations of necrotizing enterocolitis include altered vital signs like blood pressure, heart and breathing rate, and body temperature.

It is a destruction infection in which the intestinal cells and tissues get necrotized (dead). In more severe cases, the destruction of the intestinal (stomach) cells eventually results in a hole in the intestinal wall, medically called intestinal perforation. It renders a pathway for the bacteria to gain access into the baby’s bloodstream, and from there, it can reach various other organs. It can impact multiple systems in the body and even precipitate multi-organ failures.

What Are Low Birth Weight Infants?

Babies with birth weight appreciably less than the normal range are categorized under low birth weight infants. Birth weight often reflects a baby’s nutrition within the mother's womb. Various studies have illustrated the contribution of low birth weight to the perinatal death rate. Babies with a birth weight under five pounds and eight ounces are marked as low birth weight (LBW) babies, and if it falls below three pounds and five ounces, then such babies are considered very low birth weight (VLBW) babies.

Low birth weight babies are often the result of a preterm birth, where the baby is delivered prematurely before attaining the intended growth and development. Thirty-seven weeks is the estimated normal pregnancy duration, during which the baby in the womb attains the desired growth to begin the journey outside the mother’s womb (uterus). Prematurely born infants fall behind in developing general health status, encompassing immune status, and exposing themselves to different infections. However, not all prematurely delivered babies must elicit compromised immunity or other associated issues. There are reports of preterm birth with no apparent manifestations or health issues.

Technological advancements in fetal (baby in the womb) monitoring narrow the incidence of preterm and low birth weight-associated perinatal death. Numerous statistical analyses were made, and it was found that almost five percent of low-birth-weight infants were reported with necrotizing enterocolitis.

What Are the Predictors of Necrotizing Enterocolitis in Infants Born With Low Birth Weight?

Low birth weight infants are exposed to the risk of developing necrotizing enterocolitis. It is recognized as a multifactorial disease, where many influential factors contribute to developing this grave neonatal (newly born) intestinal infection. Some of the identified predictors of necrotizing enterocolitis in newly born babies with a marked reduction in birth weight include the following:

• Preterm Birth: Low birth weight and premature birth are more or less interrelated. Babies born prematurely have compromised immune functions, predisposing the newborn to intestine infections. In addition, such babies' intestines are also delicate and incapacitated to resist bacterial infections. All these factors point to an enhanced risk for necrotizing enterocolitis.

• Congenital Heart Disease: Any form of structural or functional disparities in the heart that develop by birth are broadly described as congenital heart disease. Inborn heart conditions are another important predictor for necrotizing enterocolitis, particularly in babies with low birth weight.

• Growth Restriction: Babies with appreciable limitations in growth are also recognized as a predictor. Growth restriction precipitates diminished immune status, predisposing the child to infectious conditions. When coupled with compromised immunity, the poorly developed gastrointestinal (digestive) system works as a risk factor for necrotizing enterocolitis.

• Tube Feeding: In sure babies who are reluctant to breastfeed or suffer from certain medical conditions, feeding will be done with the help of a special tube that acts as a passage for the food to reach the baby’s stomach. This form of feeding is medically coined as enteral feeding or tube feeding. Babies fed via tube are at an elevated risk of necrotizing enterocolitis, as the probability of acquiring intestinal infection is higher in such babies. Studies have concluded that more than 90 percent of the low birth weight babies who are tube-fed manifested necrotizing enterocolitis.

• Maternal Disease Conditions: During pregnancy, certain expectant mothers develop pregnancy-associated illnesses. Maternal health status can directly reflect the baby’s health inside the womb. The pregnancy-associated rise in maternal blood pressure is a known factor that influences the development of necrotizing enterocolitis in babies born with low birth weight.

• Blood Transfusion: It is a process by which either blood or its components are introduced into one's body. A blood transfusion for a low birth weight baby enhances the baby’s risk for developing necrotizing enterocolitis and is hence considered a critical predictor.

• Sepsis: Low birth weight babies are susceptible to various bacterial infections, including sepsis. It is the body’s ultimate reaction to an underlying infection in the body, where the immunity triggers a cascade of reactions. Low birth weight babies diagnosed with sepsis are vulnerable to necrotizing enterocolitis.

• Genetic Factors: Certain studies have exposed the influence of genes in precipitating necrotizing enterocolitis in babies with considerably collapsed birth weight. However, no specific genes were recognized, which is still being discussed.

Conclusion

Low birth weight is a critical factor that can expose the child to various grave conditions. Necrotizing enterocolitis is a critical illness that is more often reported in low birth weight infants. Even in low birth weight babies, certain influential factors evoke the development of necrotizing enterocolitis. At the same time, certain protective factors offer defense for low birth weight babies against necrotizing enterocolitis. Prompt breastfeeding aids in enhancing the baby’s immune status. It eventually suppresses or collapses the probability of developing infections in the baby’s body. In addition, probiotic supplements encompassing good bacteria responsible for keeping the gut healthy and immune have demonstrated appreciable defense against necrotizing enterocolitis. Low birth weight babies with multiple risk factors can benefit from probiotic feeding as it can potentially enhance the baby's gut health, thereby hindering the development of necrotizing enterocolitis.