Lumen illuminated : Intestinal defense mechanisms in the neonate

Preterm births constituted 7.6% of live births in 2007 in the Netherlands (http://www. perinatreg.nl). In the United States, premature infants comprised 12.8% of live births and the incidence of premature live births is rising because of the improved perinatal care. With the rising incidence of preterm births and the improving survival rates of (extremely) very low birth weight neonates, efforts to decrease morbidity concerning short and long term outcome remain a challenge in the neonatal intensive care unit (NICU). Necrotizing enterocolitis (NEC) is the most common surgical emergency involving the gastrointestinal tract of preterm neonates and affects 2-7% of all premature infants. Both the incidence of NEC and its fatality rate are inversely related to birth weight and gestational age. Treatment is still limited to immediate restriction of enteral feeds and broad-spectrum antibiotics. Although most cases of NEC are managed medically, an estimated 20-40% of infants undergo surgery. Mortality rates from NEC range from 15-30% but mortality rates for infants requiring surgery are as high as 50%, and are highest for the smallest, most immature infants. Survivors of NEC are at increased risk for complications such as short bowel syndrome and impaired neurodevelopment. Stoll and colleagues reported that between 18 and 22 months of corrected gestational age, infants who recovered from NEC in the postnatal period were at high risk for adverse outcomes, including poor growth, cerebral palsy, vision and hearing impairment, and decreased neuromotor development. Furthermore, infants who are surgically treated are more likely to have growth impairment and adverse neurodevelopmental outcomes than infants who were treated medically.

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