Institute Activities and Advances
The NICHD's Pregnancy and Perinatology Branch (PPB) supports a wide range of research on necrotizing enterocolitis (NEC). Recent PPB -supported studies have produced the following findings:
- Supplementation with oral epidermal growth factor reduces both the incidence and severity of NEC in rats, suggesting a therapeutic approach for both the prevention and treatment of NEC.
- H2-blockers, a common type of medication given to infants for acid reflux, slightly increase the risk for NEC.
- Steroids given to pregnant women who are at risk for preterm delivery reduce the risk of NEC in infants born at 22 weeks of gestation.
- Very low birth weight Down syndrome infants are at a higher risk for death due to NEC and other conditions than are very low birth weight infants without Down syndrome.
- Very low birth weight infants who acquire infections, including NEC, in the newborn period are more likely to have developmental impairments than similar infants who do not acquire infections.
In addition, the Pediatric Growth and Nutrition Branch studies ways to identify infants at risk for NEC and to prevent this condition. Researchers investigating feeding supplementation with prebiotics and probiotics have shown that altering bacterial populations in the infant gut may have promise. They are exploring ways to replace aggressive pathological organisms with organisms commonly found in the human gastrointestinal tract that cause no harm.
Other Activities and Advances
- The NICHD Neonatal Research Network (NRN), funded by the PPB, is a network of academic centers that aim to answer critical research questions pertaining to the advancement of neonatal care.
- Recent network studies included an observational trial of NEC that found survival was only 51% after hospital discharge in infants who had surgery for NEC or intestinal perforation. Follow-up at 18 months found continued poor outcomes. Children who underwent laparotomy, which involves making a large incision in the abdomen and removing dead tissue, were less likely to have neurodevelopmental impairment than were those who underwent intestinal drain placement, also called primary peritoneal drainage. The latter technique involves a small incision and the insertion of a 4-inch soft drain tube. A randomized trial comparing drain versus laparotomy is under way.
- NRN data was also used to create an Extremely Preterm Birth Outcomes Tool, a resource that allows a researcher or health care provider to enter a set of characteristics, including gestational age at birth, weight, sex, etc., and get average outcomes from the database for the group of infants with those characteristics. The tool is not intended to predict an outcome for a specific infant.
- The NICHD’s Best Pharmaceuticals in Children Act (BPCA) Activities, supported through the Obstetric and Pediatric Pharmacology and Therapeutics Branch, include studies of antibiotic treatments for NEC and their short- and long-term effects on infant health.
- The PPB supports the systematic reviews conducted by the Cochrane Neonatal Review Group on topics related to neonatal health, including NEC.