Management of Active Phase Necrotizing Enterocolitis in Preterm Infants

Initial Management

• The American Academy of Pediatrics recommends immediate implementation of bowel rest, broad-spectrum antibiotics, fluid resuscitation, and nasogastric decompression, with surgical consultation if perforation or clinical deterioration occurs in preterm infants with active Necrotizing Enterocolitis (NEC) 1

Nutritional Support

• Ensure adequate protein intake (minimum amino acid intake of 1.0 g/kg/d) to avoid negative nitrogen balance in preterm infants with NEC 2
• Provide a minimum of 30-40 Kcal per 1g amino acids to guarantee amino acid utilization in preterm infants with NEC 2
• Consider arginine supplementation when reintroducing feeds, as it may help prevent recurrence of NEC in preterm infants 3, 4

Prevention of Recurrence

• Consider probiotic supplementation for prevention of recurrent NEC, particularly combinations of Lactobacillus spp. and Bifidobacterium spp., in preterm infants 5

Important Clinical Considerations

• The mortality rate for NEC is approximately 5% unless it involves the entire bowel, in which case mortality increases to 40-90% in preterm infants 1
• Glutamine supplementation is not recommended for infants up to two years of age with NEC 4
• Taurine should be part of amino acid solutions for infants with NEC, although optimal dosing is not well established 4