scholarly journals Enteral Feeding Interventions in the Prevention of Necrotizing Enterocolitis: A Systematic Review of Experimental and Clinical Studies

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1726
Author(s):  
Ilse H. de Lange ◽  
Charlotte van Gorp ◽  
Laurens D. Eeftinck Schattenkerk ◽  
Wim G. van Gemert ◽  
Joep P. M. Derikx ◽  
...  
Keyword(s):  
Systematic Review ◽  
Necrotizing Enterocolitis ◽  
Enteral Feeding ◽  
Intestinal Inflammation ◽  
Immune Defense ◽  
Microbial Colonization ◽  
Effective Prevention ◽  
Pathophysiological Mechanisms ◽  
Gut Colonization ◽  
Feeding Interventions

Necrotizing enterocolitis (NEC), which is characterized by severe intestinal inflammation and in advanced stages necrosis, is a gastrointestinal emergency in the neonate with high mortality and morbidity. Despite advancing medical care, effective prevention strategies remain sparse. Factors contributing to the complex pathogenesis of NEC include immaturity of the intestinal immune defense, barrier function, motility and local circulatory regulation and abnormal microbial colonization. Interestingly, enteral feeding is regarded as an important modifiable factor influencing NEC pathogenesis. Moreover, breast milk, which forms the currently most effective prevention strategy, contains many bioactive components that are known to support neonatal immune development and promote healthy gut colonization. This systematic review describes the effect of different enteral feeding interventions on the prevention of NEC incidence and severity and the effect on pathophysiological mechanisms of NEC, in both experimental NEC models and clinical NEC. Besides, pathophysiological mechanisms involved in human NEC development are briefly described to give context for the findings of altered pathophysiological mechanisms of NEC by enteral feeding interventions.

Postnatal amniotic fluid intake reduces gut inflammatory responses and necrotizing enterocolitis in preterm neonates

2013 ◽  
Vol 304 (10) ◽  
pp. G864-G875 ◽  
Author(s):  
Jayda Siggers ◽  
Mette V. Østergaard ◽  
Richard H. Siggers ◽  
Kerstin Skovgaard ◽  
Lars Mølbak ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Necrotizing Enterocolitis ◽  
Enteral Feeding ◽  
Intestinal Inflammation ◽  
Inflammatory Responses ◽  
Preterm Neonates ◽  
Gut Colonization ◽  
Tnf Α ◽  
Before And After ◽  
And Migration

Preterm neonates are susceptible to gastrointestinal disorders such as necrotizing enterocolitis (NEC). Maternal milk and colostrum protects against NEC via growth promoting, immunomodulatory, and antimicrobial factors. The fetal enteral diet amniotic fluid (AF), contains similar components, and we hypothesized that postnatal AF administration reduces inflammatory responses and NEC in preterm neonates. Preterm pigs (92% gestation) were delivered by caesarean section and fed parental nutrition (2 days) followed by enteral (2 days) porcine colostrum (COLOS, n = 7), infant formula (FORM, n = 13), or AF supplied before and after introduction of formula (AF, n = 10) in experiment 1, and supplied only during the enteral feeding period in experiment 2 (FORM, n = 16; AF, n = 14). The NEC score was reduced in both AF and COLOS pigs, relative to FORM, when AF was provided prior to full enteral feeding (9.9 and 7.7 compared with 17.3, P < 0.05). There was no effect of AF when provided only during enteral feeding. AF pigs showed decreased bacterial abundance in colon and intestinal inflammation-related genes (e.g., TNF-α, IL-1α, IL-6, NOS) were downregulated, relative to FORM pigs with NEC. Anti-inflammatory properties of AF were supported by delayed maturation and decreased TNF-α production in murine dendritic cells, as well as increased proliferation and migration, and downregulation of IL-6 expression in intestinal cells (IEC-6, IPEC-J2). Like colostrum, AF may reduce NEC development in preterm neonates by suppressing the proinflammatory responses to enteral formula feeding and gut colonization when provided before the onset of NEC.

scholarly journals Clinical and microbiological pathogenetic parallels with necrotizing enterocolitis in preterm infants Evidence-based prevention opportunities

2019 ◽  
Vol 19 (3) ◽  
pp. 166-173
Author(s):  
Irina A. Belyaeva ◽  
E. P. Bombardirova ◽  
N. A. Kharitonova ◽  
T. V. Potekhina ◽  
P. E. Sadchikov
Keyword(s):  
Necrotizing Enterocolitis ◽  
Defense Mechanisms ◽  
Intestinal Inflammation ◽  
Severe Disease ◽  
Intestinal Barrier ◽  
Immune Defense ◽  
Microbial Colonization ◽  
Perinatal Morbidity ◽  
New Concepts

There are summarized data of domestic and foreign publications on the issue of necrotizing enterocolitis (NEC) in children born prematurely. There is presented the trend of the prevalence of this pathology in the last decade, especially epidemiology and significance of NEC in the structure of perinatal morbidity and mortality. There were analyzed new concepts on etiology and pathogenesis of the disease. In recent years, there was descripted the key role of some risk factors for the development of NEC - immatureness of intestinal barrier functions, local and systemic immunity, reduced tolerance to enteral nutrition (especially in the absence of breast-feeding), inadequate microbial colonization of the immature gastrointestinal tract. Modern research methods allow us to decipher subtle mechanisms of activation of the cascade of the intestinal inflammation and breakdown of the immune defense mechanisms. There are established cellular and humoral compartments of the immune response in NEC; there were revealed typical deviations in intestinal microbiota. The investigation of etiopathogenetical NEC factors is the basis for the development of targeted methods of the prevention and treatment of this severe disease in premature infants, including with the use of probiotics. There are presented data that the use of probiotics significantly reduces the incidence of severe NEC and mortality risk from NEC.

scholarly journals Earlier re-initiation of enteral feeding after necrotizing enterocolitis decreases recurrence or stricture: a systematic review and meta-analysis

2020 ◽  
Vol 40 (11) ◽  
pp. 1679-1687
Author(s):  
Ekta U. Patel ◽  
Dulaney A. Wilson ◽  
Emily A. Brennan ◽  
Aaron P. Lesher ◽  
Rita M. Ryan
Keyword(s):  
Systematic Review ◽  
Necrotizing Enterocolitis ◽  
Enteral Feeding ◽  
Meta Analysis

Initiation of Enteral Feeding After Necrotizing Enterocolitis

2017 ◽  
Vol 28 (01) ◽  
pp. 044-050 ◽  
Author(s):  
Hiromu Miyake ◽  
Yuhki Koike ◽  
Shogo Seo ◽  
Alison Hock ◽  
Yong Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Necrotizing Enterocolitis ◽  
Enteral Feeding ◽  
Meta Analysis ◽  
Analysis Data ◽  
Adverse Outcomes ◽  
Antibiotic Administration ◽  
Recurrence Rates ◽  
Feeding Groups ◽  
Prisma Statement

Introduction Management of necrotizing enterocolitis (NEC) consists of cessation of enteral feeding, intravenous antibiotic administration, and supportive treatment. There is no evidence-based recommendation regarding when to restart feeding after a NEC episode. We performed a systematic review and meta-analysis to examine the effect of timing of enteral feeding reinitiation on NEC recurrence. Methods MEDLINE, Embase, Google scholar, and Cochrane databases were searched. Human studies evaluating enteral feeding timing with a primary outcome of NEC recurrence were included. A total of 2,257 titles or abstracts were screened, and 47 full-text articles were analyzed. A systematic review and meta-analysis comparing NEC recurrence and other associated outcomes between early (<5 days after NEC diagnosis) and delayed (>5 days) initiation of enteral feeding after NEC were performed according to the PRISMA statement. The meta-analysis data were analyzed using RevMan 5.3 to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Results Two retrospective observational studies met the inclusion criteria, comprising 56 cases in which enteral feeding was started early and 35 cases of delayed enteral feeding initiation. There were no randomized controlled trials (RCTs). The recurrence rates of NEC were unchanged between early (5.4%) and delayed (8.6%) enteral feeding groups (pooled OR = 0.61; 95% CI: 0.12–3.16; p = 0.56; I 2 = 0%). Catheter-related sepsis (pooled OR = 0.20; 95% CI: 0.01–3.29; p = 0.26; I 2 = 67%) and post-NEC stricture (pooled OR = 0.28; 95% CI: 0.07–1.18; p = 0.08; I 2 = 23%) rates were not different between early and delayed enteral feeding groups. Conclusion Initiating early enteral feeding, within 5 days of NEC diagnosis, is not associated with adverse outcomes, including NEC recurrence. In addition, catheter-related sepsis and post-NEC stricture rates were unchanged between early and delayed enteral feeding groups after NEC. However, the quality of the evidence from the review of literature is suboptimal. A further RCT is needed to confirm these results.

Attitudes Toward Intimate Partner Violence Against Women in the European Union: A Systematic Review

2020 ◽  
Vol 25 (2) ◽  
pp. 104-121 ◽  
Author(s):  
Enrique Gracia ◽  
Marisol Lila ◽  
Faraj A. Santirso
Keyword(s):  
Systematic Review ◽  
Intimate Partner Violence ◽  
Violence Against Women ◽  
Partner Violence ◽  
Public Health Problem ◽  
Intimate Partner ◽  
Cochrane Library ◽  
Effective Prevention ◽  
Partner Violence Against Women ◽  
The Eu

Abstract. Attitudes toward intimate partner violence against women (IPVAW) are increasingly recognized as central to understanding of this major social and public health problem, and guide the development of more effective prevention efforts. However, to date this area of research is underdeveloped in western societies, and in particular in the EU. The present study aims to provide a systematic review of quantitative studies addressing attitudes toward IPVAW conducted in the EU. The review was conducted through Web of Science, PsychINFO, Medline, EMBASE, PUBMED, and the Cochrane Library, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. This review aimed to identify empirical studies conducted in the EU, published in English in peer-reviewed journals from 2000 to 2018, and analyzing attitudes toward IPVAW. A total of 62 of 176 eligible articles were selected according to inclusion criteria. Four sets of attitudes toward IPVAW were identified as the main focus of the studies: legitimation, acceptability, attitudes toward intervention, and perceived severity. Four main research themes regarding attitudes toward IPVAW emerged: correlates of attitudes, attitudes as predictors, validation of scales, and attitude change interventions. Although interest in this research area has been growing in recent years, the systematic review revealed important gaps in current knowledge on attitudes toward IPVAW in the EU that limits its potential to inform public policy. The review outlines directions for future study and suggests that to better inform policy making, these future research efforts would benefit from an EU-level perspective.

scholarly journals AB0073 INTESTINAL PERMEABILITY IN SPONDYLOARTHRITIS: A SYSTEMATIC REVIEW OF THE LITERATURE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1067.1-1067
Author(s):  
S. Hecquet ◽  
P. Totoson ◽  
H. Martin ◽  
C. Prati ◽  
D. Wendling ◽  
...  
Keyword(s):  
Systematic Review ◽  
Disease Activity ◽  
Intestinal Permeability ◽  
Intestinal Inflammation ◽  
Intestinal Barrier ◽  
Basic Research ◽  
Final Analysis ◽  
Potential Marker ◽  
Inflammatory Drugs ◽  
Permeability Evaluation

Background:Growing evidence argue for a role of the gut in the pathophysiology of various chronic rheumatic diseases such as spondyloarthritis (SpA). This so-called “gut-joint axis” involves dysbiosis, bacterial translocation, intestinal inflammation and increase in intestinal permeability. Recent data from clinical and basic research suggested that the integrity of the intestinal barrier might be a key determinant in translating autoimmunity to inflammation, making intestinal permeability a potential marker or a target for future therapies.Objectives:To analyse the available data on intestinal permeability in SpA patients and the effects of drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) on intestinal permeability.Methods:A systematic review was conducted. Without date restriction, the following databases were searched through September 1, 2020: Medline, Embase and Cochrane. Studies with patients with SpA assessing the intestinal permeability were selected. Some of the included studies have assessed the effect of NSAIDs on intestinal permeability.Results:A total of 12 studies were included in the final analysis. The 12 studies involved a total of 268 SpA patients, including 240 ankylosing spondylitis (AS). Among the studies included, four studies used the lactulose/mannitol test, four studies used the 51Cr-ethylenediaminetetraacetic test and two studies used the polyethylene glycols test. Nine of the 12 studies reported increased intestinal permeability regardless on the method used for intestinal permeability evaluation. Four studies evaluated the link between disease activity, assessed by CRP and ESR levels, and intestinal permeability and showed no correlation between increased intestinal permeability and markers of disease activity in AS patients. As regards the effects of NSAIDs on intestinal permeability, data are controversial. Two studies, including one evaluating indomethacin, did not show any influence of NSAIDs in AS patients, one study showed an increase in intestinal permeability under NSAIDs in only 60% of the patients, another study reported increased intestinal permeability. When comparing the effect of NSAIDs in patients with AS to healthy subjects, one study reported a comparable NSAIDs-induced increase in intestinal permeability in both groups.Conclusion:The results of our review suggest that increased intestinal permeability is present in SpA patients even in the absence of NSAIDs use and regardless of the method used to assess intestinal permeability. The effects of NSAIDs on intestinal permeability in SpA patients is more controversial and further studies are needed to clarify them.Disclosure of Interests:None declared

scholarly journals Challenge in diagnosis of late onset necrotizing enterocolitis in a term infant: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gunadi ◽  
Dian Nirmala Sirait ◽  
Aditya Rifqi Fauzi ◽  
Ninditya Nugroho ◽  
Fadil Fahri ◽  
...  
Keyword(s):  
Ct Scan ◽  
Necrotizing Enterocolitis ◽  
Intestinal Inflammation ◽  
Late Onset ◽  
Gastrointestinal Disease ◽  
Early Recognition ◽  
Ileocecal Valve ◽  
Abdominal Distention ◽  
Clinical Deterioration ◽  
Wall Thickening

Abstract Background Necrotizing enterocolitis (NEC) is a common devastating inflammatory gastrointestinal disease and frequently occurs in premature infants. Here, we reported a case of late-onset NEC in a term neonate with good outcome after surgery for long-term follow-up. Case presentation Ten-week-old male came to emergency unit due to prolonged diarrhea and abdominal distention. He was born at gestational age of 40 weeks with birth weight and Apgar score of 2800 g and 7/8, respectively. He had no history of formula feeding. Two weeks before admitted to the hospital, the patient had frequent diarrhea with fever. He was found lethargic with abdominal distention, absence of bowel sounds and abdominal tenderness. Plain abdominal x-ray and CT scan showed gastric and intestinal dilatation and gasless colon, suggesting a small bowel obstruction, and bowel wall thickening indicating peritonitis, without any free subdiaphragmatic air (pneumoperitoneum). Moreover, the patient did not have a congenital heart disease. While in intensive medical treatment, he showed a continuous clinical deterioration. All findings were suggestive of intestinal inflammation with clinical deterioration, and we decided to perform an emergency exploratory laparotomy and found an ischemia along the jejunoileal with a perforation at 25 cm above the ileocecal valve. Subsequently, we performed a double-barrel ileostomy through a separate incision from the laparotomy. Histopathological findings confirmed the diagnosis of NEC. We closed the stoma at postoperative day 43. The patient was discharged uneventfully a month after stoma closure. Conclusion Abdominal CT scan might be useful to establish an early recognition of late-onset NEC; thus, immediate surgical intervention might be performed to decrease its morbidity and mortality. Moreover, late-onset NEC in term neonates might occur without any risk factors or significant co-morbidities.

NOD-Like Receptors: Guardians of Intestinal Mucosal Barriers

Physiology ◽  
2015 ◽  
Vol 30 (3) ◽  
pp. 241-250 ◽  
Author(s):  
Anne-Kathrin Claes ◽  
Jun Yu Zhou ◽  
Dana J. Philpott
Keyword(s):  
Inflammatory Bowel Disease ◽  
Pattern Recognition ◽  
Potential Function ◽  
Bowel Disease ◽  
Intestinal Inflammation ◽  
Intestinal Barrier ◽  
Immune Defense ◽  
Intestinal Infections ◽  
Gut Homeostasis ◽  
Inflammatory Bowel

The NOD-like receptors (NLRs) are cytosolic pattern-recognition receptors, which are critically involved in mucosal immune defense. The association of the NLR, NOD2, with inflammatory bowel disease first pointed to the NLRs potential function as guardians of the intestinal barrier. Since then, several studies have emphasized the importance of NLRs in maintaining gut homeostasis and intestinal infections, and in shaping the microbiota. In this review, we will highlight the function of NLRs in intestinal inflammation.

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