Guts! Dietary modulation of innate defense

Necrotizing enterocolitis (NEC) is the most common gastro-intestinal emergency in the neonatal intensive care. The incidence of NEC ranges from 0.3 to 2.4 infants per 1000 live births, with nearly 70% of cases occurring in infants born at less than 36 weeks of gestation. The incidence of NEC varies, affecting 2-5% of all premature infants.[1] The overall mortality for NEC ranges from 10% to 50%.[2] Despite optimal medical and surgical management of NEC, infants that recover from the disease suffer from substantial morbidity, such as intestinal obstruction as a consequence of scarring, liver failure due to a prolonged requirement for total parenteral nutrition, short bowel syndrome with intestinal failure and associated nutritional deficiencies, and associated defects in growth and development.[3-4] Length of hospital stay in infants with surgical NEC and medically treated NEC exceeds those of controls by 60 days and 22 days respectively. Based on length of stay, the estimated total hospital charges for infants with surgical NEC in the USA averaged $186 200 in excess of those for controls and $73 700 more for infants with medical NEC. The yearly additional hospital charges for NEC were $216 666 per survivor.[5] Hence, NEC is a significant and growing health concern for prematurely born infants. The costs in the Netherlands are not exactly known, but will not be very different. As the number of preterm births has almost doubled over the past two decades in the Netherlands (Perinatale Registratie Nederland) and the United States (National Vital Statistics Report 2003), this burden will continue to increase. In addition, recently the national policy has changed into a more liberal approach to the lower limit of viability. More very immature infants (from a gestational age of 24 weeks onwards) will be given a chance to survive, with consequently more risk of developing NEC.

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