What are pharmacologic strategies for the deterrence and prevention of necrotizing enterocolitis (NEC)?

Updated: Dec 27, 2017
  • Author: Shelley C Springer, JD, MD, MSc, MBA, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Answer

Efforts to reduce the incidence of NEC may target infection control in the newborn nursery, augmentation of premature host defenses, stimulation of GI tract maturation, inhibition of inflammatory mediators, and reduction of enteric bacterial load.

Enteral immunoglobulin A (IgA) is deficient in the premature gastrointestinal system, and oral IgA supplementation reduces the incidence of NEC in rat models. In addition, a series in human infants found that patients who received an oral IgG-IgA preparation were significantly less likely to develop NEC than were control subjects.

The administration of prenatal glucocorticoids to mothers for fetal pulmonary maturation significantly reduces the incidence of NEC. In addition, postnatal treatment decreases the incidence of NEC, although not as effectively as prenatal treatment.

In laboratory models PAF antagonists reduced bowel injury. However, their role in the prevention and treatment of NEC in humans has not been well established.

Nonabsorbable oral antibiotics have been used in attempts to reduce the intestinal bacterial load and presumably inhibit the progression of NEC. However, several investigators found no significant difference in outcome between infants receiving oral antibiotics and control subjects.

A meta-analysis of 12 trials that included 10,800 premature neonates (5,144 receiving prophylactic probiotics; 5,656 controls) revealed a significant reduction in the incidence of NEC and mortality in the prophylactic probiotic group, although the incidence of sepsis did not differ significantly between the groups. [41]


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