Contaminated milk is a common cause of necrotising enterocolitis: A hypothesis
- Author:
Nem-Yun Boo
- Publication Type:Journal Article
- Keywords:
necrotising enterocolitis;
NEC;
neonates;
milk
- From:The Malaysian Journal of Pathology
2016;38(3):223-227
- CountryMalaysia
- Language:English
-
Abstract:
Necrotising enterocolitis (NEC) is the most commonly acquired gastrointestinal disease of neonates,
particularly the very preterm (gestation <32 weeks) and/or very low birth weight (<1500g). It is
associated with high morbidity and mortality. Despite improvement in neonatal care and increased
use of expressed breast milk (EBM), the incidence remains high in many neonatal intensive care
units (NICU), and even shows increasing trend in some countries. Numerous studies have pointed
to the infective nature of NEC. Some investigators have reported an increase in the incidence of
NEC in their NICU when the percentage of infants with pathogens isolated from their gut increased,
and decreased when gut colonisation rate was low. Both bacteria and viruses have been reported to
be associated with outbreaks of NEC. The majority (>90%) of the NEC cases occurred in neonates
on enteral feeding. Studies have shown that milk (whether EBM or formula) fed to neonates was
not sterile and were further contaminated during collection, transport, storage and/or feeding. Other
investigators have reported a reduction in the incidence of NEC when they improved infection control
measures and hygienic procedures in handling milk. It is, therefore, hypothesised that the most
common cause of NEC is due to the feeding of neonates, particularly the vulnerable very preterm
small neonates, with milk heavily contaminated during collection at source, transport, storage and/or
feeding. Because of the immaturity of the immune system of the neonates, excessive inflammatory
response to the pathogen load in the gut leads to the pathogenesis of NEC.
