The most common gastrointestinal emergency faced by premature infants, necrotizing enterocolitis (NEC) is associated with serious consequences: 20% to 40% of all affected infants will require surgery and between 15% and 30% will die from the condition. Neonates who survive NEC are left at increased risk for serious problems, including short gut syndrome, strictures, and neurodevelopmental impairment.
In addition to prematurity, risk factors for NEC include being fed with formula rather than human milk and early use of antibiotics, especially if prolonged. Recent understandings have also implicated the fact that the preterm infant’s gut microbiome has fewer bacterial species, less diversity, and greater proportions of potential pathogens. This dysbiosis is now seen as a major contributor to NEC and has led to enhanced interest in supplying prebiotics and probiotics to premature infants to restore microbiome health.
This case study examines care decisions for a preterm, very-low-birthweight infant with NEC, from birth to care in the NICU, up to the time of discharge home. Considerations for optimizing the ongoing health and development of the neonate are explored in detail, as is the importance of nutritional support. The most recent data on the roles of probiotics and prebiotics in preventing and managing NEC are discussed, along with the implications of these data for routine clinical practice.