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World J Clin Pediatr. Apr 9, 2019; 8(2): 23-32
Published online Apr 9, 2019. doi: 10.5409/wjcp.v8.i2.23
Prevention of necrotizing enterocolitis in premature infants – an updated review
Yu-Ting Jin, Yue Duan, Xiao-Kai Deng, Jing Lin
Yu-Ting Jin, Yue Duan, Xiao-Kai Deng, Jing Lin, Department of Neonatology, The Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
Jing Lin, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Author contributions: Jin YT wrote the first draft; Duan Y and Deng XK contributed some sections of the draft; Lin J initiated the project and finalized the manuscript.
Conflict-of-interest statement: Dr. Lin has nothing to disclose. The other authors did not provide a conflict-of-interest statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jing Lin, MD, Associate Professor, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States. jing.lin@mssm.edu
Telephone: +1-212-241-6186 Fax: +1-212-534-5207
Received: August 25, 2018
Peer-review started: August 25, 2018
First decision: October 5, 2018
Revised: December 31, 2018
Accepted: January 28, 2019
Article in press: January 28, 2019
Published online: April 9, 2019
Processing time: 227 Days and 19.2 Hours
Abstract

Necrotizing enterocolitis (NEC) is among the most common and devastating diseases encountered in premature infants, yet the true etiology continues to be poorly understood despite decades of research. Recently, gut bacterial dysbiosis has been proposed as a risk factor for the development of NEC. Based on this theory, several best clinical practices designed to reduce the risk of NEC have been proposed and/or implemented. This review summarizes the results of recent clinical trials and meta-analyses that support some of the existing clinical practices for reducing the risk of NEC in premature infants. It is evident that human milk feeding can reduce the incidence of NEC. While most of the studies demonstrated that probiotic supplementation can significantly reduce the incidence of NEC in premature infants, there are still some concerns regarding the quality, safety, optimal dosage, and treatment duration of probiotic preparations. Antibiotic prophylaxis does not reduce the incidence of NEC, and prolonged initial empirical use of antibiotics might in fact increase the risk of NEC for high-risk premature infants. Lastly, standardized feeding protocols are strongly recommended, both for prevention of postnatal growth restriction and NEC.

Keywords: Necrotizing enterocolitis; Prevention; Human milk feeding; Probiotics; Empiric antibiotics; Standardized feeding protocols

Core tip: In this review, we summarize some of the clinical practices recommended to reduce the risk of necrotizing enterocolitis (NEC) in premature infants. Firstly, it is evident that human milk feeding can reduce the incidence of NEC. Secondly, while most of the studies demonstrated that probiotic supplementation can significantly reduce the incidence of NEC in premature infants, there are still some concerns regarding the quality of probiotic preparations, safety, optimal dosage, and treatment duration. Thirdly, initial empiric antibiotic use should be restricted in daily practice to reduce the incidence of NEC. Lastly, standardized feeding protocols are recommended both for prevention of postnatal growth restriction and NEC.