DILEMMAS AROUND NECROTIZING ENTEROCOLITIS IN LATE PRETERM NEONATES
Necrotizing enterocolitis is an acquired, multifactorial, and potentially severe gastrointestinal disease characterized by ischemia, necrosis, and inflammation of the bowel wall. It affects mostly very low birth weight preterm neonates, but approximately 10% of the cases are diagnosed in late preterm and term infants with risk factors for mesenteric ischemia like intrauterine growth restriction, polycythemia, birth asphyxia, chorioamnionitis, sepsis, or congenital gastro-intestinal or cardiac defects. In growth restricted newborns the incidence of necrotizing enterocolitis is approximately twice compared to those with adequate birth weight. In these fetuses blood flow to the brain is preserved at the expense of blood flow to other organs, including the gastrointestinal tract, which leads to mesenteric ischemia. An exclusive human milk diet might be protective due to growth factors, antibodies, cellular immune factors, probiotic bacteria, oligosaccharides, and stem cells, which are all present in fresh breastmilk.
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