Loyola researchers identify risk factor for life-threatening disease in preemies

Many premature infants suffer a life-threatening bowel infection called necrotizing enterocolitis (NEC).

Researchers at Loyola University Health System have identified a marker to identify those at risk for the infection, enabling doctors to employ early preventive strategies. These findings were published in the latest issue of the Journal of Pediatric Surgery.

"This information will allow us to better care for these premature infants," said Jonathan Muraskas, MD, study investigator and co-medical director of Loyola's neonatal ICU. "Simple changes to blood transfusion practices, feeding patterns and treatment of these infants may significantly reduce the incidence of NEC."

NEC is the most common serious gastrointestinal disorder among preterm newborns. It affects up to 10 percent of extremely low birth weight infants and has a mortality rate of nearly 30 percent. There is no known cause for the disease, yet researchers believe it may result from a combination of decreased blood flow to the bowel, feeding patterns, infection, mechanical injury or abnormal immune response.

NEC occurs when the lining of the intestinal wall dies and tissue falls off. Most cases of NEC are mild to moderate and can be successfully treated with antibiotics. But in severe cases, a hole can develop in the intestine, allowing bacteria to leak into the abdomen causing a life-threatening infection.

Necrotizing enterocolitis (NEC) is the most common gastrointestinal (GI) medical/surgical emergency occurring in neonates. An acute inflammatory disease with a multifactorial and controversial etiology, the condition is characterized by variable damage to the intestinal tract ranging from mucosal injury to full-thickness necrosis and perforation.

Necrotizing enterocolitis represents a significant clinical problem and affects close to 10% of infants who weigh less than 1500 g, with mortality rates of 50% or more depending on severity. Although it is more common in premature infants, it can also be observed in term and near-term babies. (See Epidemiology and Prognosis.)

NEC most commonly affects the terminal ileum and the proximal ascending colon. However, varying degrees of NEC can affect any segment of the small intestine or colon. The entire bowel may be involved and may be irreversibly damaged.

Numerous, vague reports in 19th-century literature report described infants who died from peritonitis in the first few weeks of life. The first half of the 20th century brought more reports of peritonitis with ileal perforation due to what was called infectious enteritis. In 1953, Scmid and Quaiser called this condition newborn NEC. The first clear report of NEC did not appear until 1964, when Berdon from the New York Babies Hospital described the clinical and radiographic findings of 21 infants with the disease.

As neonatal intensive care has progressed an d as premature newborns have come to survive long enough for the disease to develop, the incidence of NEC in neonatal intensive care units (NICUs) has increased. NEC remains one of the most challenging diseases confronted by pediatric surgeons. It likely represents a spectrum of diseases with variable causes and manifestations, and surgical care must therefore be individualized.