Phillip V Gordon1, Jonathan R Swanson2. 1. Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL, United States; Sacred Heart Children's Hospital, Pensacola, FL, United States. 2. Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States. Electronic address: jrs3yc@virginia.edu.
Abstract
BACKGROUND: The field of necrotizing enterocolitis (NEC) research has been in existence for over 60 years. During the first five decades little progress in NEC prevention and no definitive progress in treatment was achieved. One of the major determinants of this ineffectiveness may have been a global propensity to lump NEC into a single disease entity rather than a spectrum of diseases with a common outcome. The driver of this philosophy was most likely statistical, in that researchers desired large cohorts to optimize statistical power. Additionally, in the past quarter century, our preterm NEC cohorts were (and in some cases still are) contaminated with spontaneous intestinal perforations (SIP). This completely different acquired neonatal intestinal disease (ANID) markedly alters clinical characteristics and outcomes in NEC cohorts and subsets if not addressed. Unfortunately, cohort size has been proven to be less important than data quality when it comes to NEC over this last decade of research. Emerging progress in NEC prevention has been greatly enhanced as a result of dividing well-defined NEC into subsets of disease origin and investigating these entities individually. REVIEW OBJECTIVES: The purpose of this review is to offer the bedside clinician a concise, up-to-date review of recent advances in NEC reductionism. The reader should understand the history and basic theory behind NEC subsets, their application to NEC prevention, and comprehend that prevention of NEC requires a comprehensive quality improvement strategy that is likely best realized with a zero tolerance approach. CONCLUSIONS: We are entering a new era of NEC prevention. NICUs that embrace and achieve effective NEC prevention strategies will rapidly outpace their contemporaries. Because NEC is still the major driver of morbidity and mortality in most NICUs today, those who reject or fail in this pursuit will likely face increasingly severe consequences due to growing requirements for outcomes transparency.
BACKGROUND: The field of necrotizing enterocolitis (NEC) research has been in existence for over 60 years. During the first five decades little progress in NEC prevention and no definitive progress in treatment was achieved. One of the major determinants of this ineffectiveness may have been a global propensity to lump NEC into a single disease entity rather than a spectrum of diseases with a common outcome. The driver of this philosophy was most likely statistical, in that researchers desired large cohorts to optimize statistical power. Additionally, in the past quarter century, our preterm NEC cohorts were (and in some cases still are) contaminated with spontaneous intestinal perforations (SIP). This completely different acquired neonatal intestinal disease (ANID) markedly alters clinical characteristics and outcomes in NEC cohorts and subsets if not addressed. Unfortunately, cohort size has been proven to be less important than data quality when it comes to NEC over this last decade of research. Emerging progress in NEC prevention has been greatly enhanced as a result of dividing well-defined NEC into subsets of disease origin and investigating these entities individually. REVIEW OBJECTIVES: The purpose of this review is to offer the bedside clinician a concise, up-to-date review of recent advances in NEC reductionism. The reader should understand the history and basic theory behind NEC subsets, their application to NEC prevention, and comprehend that prevention of NEC requires a comprehensive quality improvement strategy that is likely best realized with a zero tolerance approach. CONCLUSIONS: We are entering a new era of NEC prevention. NICUs that embrace and achieve effective NEC prevention strategies will rapidly outpace their contemporaries. Because NEC is still the major driver of morbidity and mortality in most NICUs today, those who reject or fail in this pursuit will likely face increasingly severe consequences due to growing requirements for outcomes transparency.
Authors: B C MacQueen; R D Christensen; C C Yost; D K Lambert; V L Baer; M J Sheffield; P V Gordon; M J Cody; E Gerday; R Schlaberg; J Lowe; J G Shepherd Journal: J Perinatol Date: 2016-07-07 Impact factor: 2.521
Authors: Nagender Ledala; Mishika Malik; Karim Rezaul; Sara Paveglio; Anthony Provatas; Aaron Kiel; Melissa Caimano; Yanjiao Zhou; Jonathan Lindgren; Kristyna Krasulova; Peter Illes; Zdeněk Dvořák; Sandhya Kortagere; Sabine Kienesberger; Amar Cosic; Lisa Pöltl; Ellen L Zechner; Subho Ghosh; Sridhar Mani; Justin D Radolf; Adam P Matson Journal: mBio Date: 2022-01-25 Impact factor: 7.867