NICHD Necrotizing Enterocolitis (NEC) Research Information

NICHD-supported research on necrotizing enterocolitis (NEC) focuses on fetal growth, such as the development of the gastrointestinal system and digestive function; identification of infants at risk for NEC; prevention of this disorder, such as through research on the feeding of premature newborn infants; the roles of breastfeeding and prebiotics/probiotics in the prevention of NEC; and comparing treatments, such as different surgical techniques. NICHD is involved in the search for better treatments for NEC and supports studies of the long-term outcomes of interventional surgery as well as the long-term effects of the disease.

The goals of NICHD research on necrotizing enterocolitis (NEC) include:

  • Developing a better understanding of the causes of the disease.
  • Finding ways to identify newborns at risk for developing NEC.
  • Finding ways to prevent the development of NEC.
  • Developing better treatments for the disease; for example, by comparing outcomes of various surgical techniques.
  • Understanding the long-term effects of NEC in infants who survive the disease.

Institute Activities and Advances

NICHD's Pregnancy and Perinatology Branch (PPB) supports a wide range of research on NEC. Recent PPB-supported studies have produced the following findings:

  • Supplementation with oral epidermal growth factor reduces both the incidence and severity of NEC in rats, suggesting a therapeutic approach for both the prevention and treatment of NEC.
  • H2-blockers, a common type of medication given to infants for acid reflux, slightly increase the risk for NEC.
  • Steroids given to pregnant women who are at risk for preterm delivery reduce the risk of death or NEC in infants born at 22 weeks of gestation.
  • Very low birth weight Down syndrome infants are at a higher risk for death due to NEC and other conditions than are very low birth weight infants without Down syndrome.
  • Very low birth weight infants who acquire infections, including NEC, in the newborn period are more likely to have developmental impairments than similar infants who do not acquire infections.

In addition, the Pediatric Growth and Nutrition Branch studies ways to identify infants at risk for NEC and to prevent this condition. Researchers investigating feeding supplementation with prebiotics and probiotics have shown that altering bacterial populations in the infant gut may have promise. They are exploring ways to replace aggressive pathological organisms with organisms commonly found in the human gastrointestinal tract that cause no harm.

Other Activities and Advances

  • The NICHD Neonatal Research Network (NRN), funded by the PPB, is a network of academic centers that aim to answer critical research questions pertaining to the advancement of neonatal care.
    • Recent network studies included an observational trial of NEC that found survival was only 51% after hospital discharge in infants who had surgery for NEC or intestinal perforation. Follow-up at 18 months found continued poor outcomes. Children who underwent laparotomy, which involves making a large incision in the abdomen and removing dead tissue, were less likely to have neurodevelopmental impairment than were those who underwent intestinal drain placement, also called primary peritoneal drainage. The latter technique involves a small incision and the insertion of a soft drain tube. A randomized trial comparing drain versus laparotomy for outcomes at 18 months is under way.
  • NICHD's Best Pharmaceuticals in Children Act (BPCA) Activities, supported through the Obstetric and Pediatric Pharmacology and Therapeutics Branch, include studies of antibiotic treatments for NEC and their short- and long-term effects on infant health.

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