Pathogenesis and prevention of necrotizing enterocolitis: a hypothesis based on personal observation and a review of the literature.

Abstract:

:The hypothesis is, that necrotizing enterocolitis (NEC) of the neonate occurs by the coincidence of two of three pathologic events: (1) intestinal ischemia, (2) colonization by pathogenic bacteria, and (3) excess protein substrate in the intestinal lumen. NEC is more likely to appear following quantitative extremes, ie, severe ischemia highly pathogenic flora, or marked excess of substrate. NEC develops only if a threshold of injury, sufficient to initiate intestinal necrosis, is exceeded. The hypothesis is derived from previous theories by Santulli, which implicated all three events, and by Lawrence, in which a single event, abnormal bacterial colonization, was considered sufficient to induce NEC. This hypothesis may explain both typical occurrences of NEC among high-risk premature infants in neonatal intensive care units (NICUs), and atypical occurrences among infants considered at low-risk, eg, previously healthy term infants, infants fed breast milk exclusively, and infants never fed. It may further explain why NEC fails to develop in most high-risk infants in NICUs. Preventive measures might include: (1) pharmacologic stabilization of intestinal perfusion, (2) modification of the intestinal flora, or (3) feeding colostrum or other protective substances. Each theoretical benefit is accompanied by potential risks. The prevention of NEC may require favorable intervention in two of the three pathologic events.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Kosloske AM

subject

Has Abstract

pub_date

1984-12-01 00:00:00

pages

1086-92

issue

6

eissn

0031-4005

issn

1098-4275

journal_volume

74

pub_type

杂志文章,评审
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  • Is more neonatal intensive care always better? Insights from a cross-national comparison of reproductive care.

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    doi:10.1542/peds.109.6.1036

    authors: Thompson LA,Goodman DC,Little GA

    更新日期:2002-06-01 00:00:00

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Cervenka J,Arthur D,Yasis C

    更新日期:1981-01-01 00:00:00

  • The changing role and responsibilities of chairmen in clinical academic departments: the transition from autocracy.

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    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

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    更新日期:1992-07-01 00:00:00

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    更新日期:2006-07-01 00:00:00

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    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1542/peds.2020-1240

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    authors: al Naqeeb N,Edwards AD,Cowan FM,Azzopardi D

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    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2007-2951

    authors: Read JS,Committee on Pediatric AIDS, American Academy of Pediatrics.

    更新日期:2007-12-01 00:00:00

  • Community physician's role in case management of children with chronic illnesses.

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    doi:

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    更新日期:1989-09-01 00:00:00

  • Suicide and suicide attempts in adolescents. Committee on Adolescents. American Academy of Pediatrics.

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    更新日期:2000-04-01 00:00:00

  • A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign.

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    authors: Ellsbury DL,Clark RH,Ursprung R,Handler DL,Dodd ED,Spitzer AR

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  • Variability in Very Preterm Stillbirth and In-Hospital Mortality Across Europe.

    abstract:BACKGROUND AND OBJECTIVE:Stillbirth and in-hospital mortality rates associated with very preterm births (VPT) vary widely across Europe. International comparisons are complicated by a lack of standardized data collection and differences in definitions, registration, and reporting. This study aims to determine what prop...

    journal_title:Pediatrics

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    doi:10.1542/peds.2016-1990

    authors: Draper ES,Manktelow BN,Cuttini M,Maier RF,Fenton AC,Van Reempts P,Bonamy AK,Mazela J,Bᴓrch K,Koopman-Esseboom C,Varendi H,Barros H,Zeitlin JJ,EPICE Cohort.

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    authors: Vogt H,Lindström K,Bråbäck L,Hjern A

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    abstract::Although bone age estimates are traditionally used to monitor children receiving growth hormone therapy, few data support this practice. Bone age determination is fraught with technical difficulties, resulting in high interobserver differences. Longitudinal studies show that an individual's bone age can change erratic...

    journal_title:Pediatrics

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  • Effect of maternal lead burden on infant weight and weight gain at one month of age among breastfed infants.

    abstract:INTRODUCTION:Transfer of lead from bone to the bloodstream increases during lactation. However, the effect of maternal lead burden on growth in breastfed newborns is still unknown. This study examined early postnatal growth in a cohort of healthy breastfed newborns in relation to maternal bone lead burden. METHODS:Lea...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.107.5.1016

    authors: Sanín LH,González-Cossío T,Romieu I,Peterson KE,Ruíz S,Palazuelos E,Hernández-Avila M,Hu H

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  • Principles of Care for Young Adults With Co-Occurring Psychiatric and Substance Use Disorders.

    abstract::Over 50% of young adults (defined as individuals aged 18-25 years) with substance use disorders (SUDs) have at least 1 co-occurring psychiatric disorder, and the presence of co-occurring disorders worsens SUD outcomes. Treatment of both co-occurring psychiatric disorders and SUDs in young adults is imperative for opti...

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    authors: Spencer AE,Valentine SE,Sikov J,Yule AM,Hsu H,Hallett E,Xuan Z,Silverstein M,Fortuna L

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    doi:10.1542/peds.2011-3779

    authors: Martin DP,Bhalla T,Rehman S,Tobias JD

    更新日期:2013-01-01 00:00:00

  • Disparities in Service Use Among Children With Autism: A Systematic Review.

    abstract:CONTEXT:Research reveals racial, ethnic, and socioeconomic disparities in autism diagnosis; there is limited information on potential disparities related to other dimensions of services. OBJECTIVE:We reviewed evidence related to disparities in service use, intervention effectiveness, and quality of care provided to ch...

    journal_title:Pediatrics

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    doi:10.1542/peds.2019-1895G

    authors: Smith KA,Gehricke JG,Iadarola S,Wolfe A,Kuhlthau KA

    更新日期:2020-04-01 00:00:00

  • Identification of Extremely Premature Infants at Low Risk for Early-Onset Sepsis.

    abstract:BACKGROUND:Premature infants are at high risk of early-onset sepsis (EOS) relative to term infants, and most are administered empirical antibiotics after birth. We aimed to determine if factors evident at birth could be used to identify premature infants at lower risk of EOS. METHODS:Study infants were born at 22 to 2...

    journal_title:Pediatrics

    pub_type: 杂志文章,多中心研究

    doi:10.1542/peds.2017-0925

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  • Safety of Quadrivalent Meningococcal Conjugate Vaccine in 11- to 21-Year-Olds.

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    journal_title:Pediatrics

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    doi:10.1542/peds.2016-2084

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    更新日期:2017-01-01 00:00:00

  • Marriage and the well-being of children.

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