A pregnancy lasts approximately 40 weeks. However, some babies are born prematurely and we speak of premature babies (born before 37 weeks).
In our country, one in ten babies is premature and, although much medical progress has been made in the field of prematurity, these babies can suffer from different diseases and complications due to being born prematurely. Among them is necrotizing enterocolitis, the most frequent and serious intestinal pathology in premature infants .
What is necrotizing enterocolitis?
It is an inflammation of the intestine that can damage the walls. If this damage is very serious, a break in the wall can occur, which is known as intestinal perforation. In these cases, the baby will need surgery.
It is more frequent the smaller the baby. In our country, around 7% of newborns weighing less than 1500g at birth suffer from necrotizing enterocolitis. This usually appears between the second and fourth weeks of life.
What are the risk factors for enterocolitis?
It is unknown exactly why this disease occurs, but it is known that there are several factors involved.
As we have just commented, one of the main risk factors is prematurity . The more premature a baby is, the more likely it is to have enterocolitis. The immaturity of his gut appears to be a key factor. In full-term children it is much less frequent and, if it does appear, it is usually in newborns with another pathology (heart disease, perinatal asphyxia, respiratory disease…).
Infections, lack of blood supply, and formula feeding are also implicated.
What are your symptoms?
The symptoms of this disease are highly variable and nonspecific, that is, they can appear in many other situations and are not exclusive to this pathology.
Digestive symptoms usually appear: vomiting , swollen abdomen, slow gastric emptying, bloody stools or pain when touching the gut .
General symptoms may also appear, such as a drop in blood pressure, poor general condition, decay or apnea pauses (episodes in which they stop breathing for a few seconds).
How is it diagnosed?
With the aforementioned clinic it is suspected. A blood test is usually carried out to see possible alterations (there may be a drop in platelets, coagulation alterations, inflammation data…), an abdominal X-ray , which usually confirms the diagnosis and can guide us in the follow-up and collection of cultures to see if any microorganisms grow.
In the X- ray you can see data of intestinal inflammation and perforation if there has been one. Abdominal ultrasound may also be helpful.
How is it treated?
Treatment depends on how advanced the disease is. The baby must remain on an absolute diet so that the intestine can rest (it will be fed through a line with serum or parenteral nutrition), a nasogastric tube is usually placed and antibiotic treatment is given. In case of perforation, it must be operated .
Can it be prevented?
To this day, we still lack a lot of information about this disease and different strategies to prevent it continue to be investigated. Breastfeeding is the measure that has been shown to be most effective in prevention .
The administration of probiotics to very preterm and very low birth weight infants could also reduce the risk of enterocolitis; as well as the early start of feeding, even if they are very small amounts (this is what is called trophic feeding).
The importance of breast milk in the prevention of enterocolitis
As we have just commented, breast milk is the main protective factor against enterocolitis .
According to research, a formula -fed newborn has a 6-10 times higher risk of enterocolitis than a exclusively breastfed newborn .
If you receive mixed breastfeeding, the risk can be up to 3 times less of suffering from enterocolitis than if you receive only formula.
In addition, exclusively breastfed premature infants also have a lower risk of severe enterocolitis (requiring surgery). For this reason, it is of vital importance that Neonatology units have professionals capable of encouraging and helping mothers to achieve successful breastfeeding. Premature babies often cannot eat for the first few days, or if they do, it is through a nasogastric tube and not directly to the breast, making these feedings especially difficult.
When the mother’s own breast milk is not available, the second best option is donated breast milk . The differences between feeding a premature baby with formula or donated breast milk have been studied, and it has been proven that receiving formula increases the risk of suffering from enterocolitis. Thus, breast milk is considered a medicine for premature babies and breast milk banks have a very important function for these babies. In them, milk is collected from mothers who decide to donate it, it is analyzed and processed so that it is an optimal food for premature newborns who cannot receive milk from their mother (or who cannot receive all the necessary amount).
Regarding the mechanisms by which breast milk protects against enterocolitis, it is known that it contains growth factors, hormones and free amino acids, among others, that stimulate the maturation of the gastrointestinal tract as well as its motility . In addition, it contains anti-inflammatory substances and elements that promote immunity , such as immunoglobulins A and E.
On the other hand, breast milk has a protective role against infections and facilitates the colonization of the intestinal tract by beneficial bacteria , such as Lactobacillus or bifidobacteria.
