Necrotizing Enterocolitis: Insights Into Pathogenesis, Diagnosis And Treatment

Necrotizing enterocolitis (NEC), described over 30 years ago, remains the leading cause of death in premature infants from gastrointestinal disease. It is axiomatic that NEC is both a devastatingly serious disease and one in which its very underpinnings remain a mystery.The disease develops quickly and without warning. Every clinician who takes care of neonates will attest to the typical scenario of a premature infant who is at first clinically stable, then subtly begins to manifest a series of symptoms which progress — often quite rapidly — from feeding intolerance, abdominal distention and bloody stools, to outright sepsis and hemodynamic instability. Every surgeon who operates on these fragile patients will have experienced the scenario where laparotomy reveals the presence of patchy necrosis of the intestine with a distribution and severity which may or may not match the clinical impression that was present preoperatively. A large number of studies have revealed that neither the type of surgery that is performed on patients with NEC, nor its timing, can significantly alter outcomes in patients with this disease. These clinical impressions reveal the highly variable nature of patients with NEC, and also underscore the fact that if we are to improve the outcome of these young children, then a clearer understanding of the pathogenesis of NEC at the molecular level is required.This textbook will focus on all major schools of thought regarding the factors that lead to the development of NEC, and will address the current scientific approach to the development of appropriate treatments. In addition, this book will address the complex social, ethical, nursing and rehabilitative issues that clinicians face when caring for patients with NEC. Finally, a significant focus of the book will be devoted to the scientific underpinnings of this disease, and the successes so far in the development of novel therapeutic approaches based upon these scientific discoveries.