This is the first textbook devoted entirely to understanding and treating necrotizing enterocolitis (NEC), one of the leading causes of death and disability in premature infants. NEC continues to occur in neonatal units across the world, and the overall mortality has remained stubbornly high since its first description decades ago. Despite significant research into NEC, and a greater understanding of its underlying causes, there is no single source of information to which the care team can turn for guidance. This book fills that important gap in clinical care.
In selecting the topics for this inaugural textbook, three guiding principles have been followed. First, to include chapters that provide detailed information for the medical team – the doctors and nurses, the therapists and pharmacists, the chaplains and the child life workers – so that each team member can optimally recognize, prevent and treat patients with this disease. Second, to ensure that chapters cover the depth and breadth of the latest clinical and scientific research into NEC, each selected to identify specific preventative strategies or therapies for this disease. Third, and perhaps most importantly, to focus not only on the child with NEC, but also on the child’s family, in order to provide comprehensive information about a disease that families have barely heard about, until the jarring day when their precious infant is affected by it.
This book therefore:
- serves as a "how-to guide" for the care of the infant with NEC
- summarises critical new research and offers guidelines for future key research areas
- addresses the complex and difficult issues surrounding care of the critically ill infant suffering from NEC
Written for the entire health care team including paediatric surgeons, neonatologists, developmental paediatricians, epidemiologists, ethicists, child life professionals, therapists and specialist nurses, each team member will find this book of value. This book was written to demystify this cruel disease, and to unlock its closely held secrets of pathogenesis, diagnosis, treatment and prevention.
Table of Contents
Clinical considerations: Epidemiology, definitions, diagnosis and management. Introduction. Nursing considerations in NEC: management of infant stomas. Nursing considerations in NEC: management of central venous catheters. An updated overview of the medical management of NEC.Clinical clues, biochemical indices and biomarkers: Diagnostic considerations in NEC. Imaging considerations in NEC diagnosis: plain films, ultrasound, and everything else.Spontaneous Intestinal Perforation (SIP) is not NEC (NEC) but remains the major confounder of NEC data. Practice Patterns in NEC Management: North America, Europe and Australasia. Feeding strategies in the patient with NEC.Surgery for NEC: Indications, techniques, and outcomes. Major issues related to progress in NEC. Probiotics in the prevention of NEC. Cardiovascular, hemodynamic, and critical care considerations in the patient with NEC. Neurodevelopmental considerations in the patient with NEC.Lung Disease and Ventilator Strategies in NEC. Clinical trials in NEC research: advances, perils and pitfalls. Management of Short Bowel Syndrome after NEC. NEC in unusual cases: term infants, congenital anomalies, comorbidities. Intestinal transplantation for NEC.Optical spectroscopy for the detection of NEC. Anesthetic Management of the Neonate with NEC. Novel and alternative techniques in surgery for NEC. Supporting NEC Risk Awareness with Bedside Tools like GutCheck. Societal and community considerations. Health Economics and Care Delivery Issues in NEC. Quality Improvement and NEC. Implementation strategies for Quality Improvement to avoid NEC. Clinical outcomes in children with NEC. Contextualizing NEC within health disparities research. Ethical Issues in the Care of Children with NEC.Family perspective of NEC. Biochemical and molecular considerations in the pathogenesis of NEC. The role of Toll Like Receptor (TLR) signaling in the pathogenesis of NEC.The role of growth factor signaling in the development and treatment of NEC.The role of platelet activating factor in the pathogenesis of NEC. The role of vascular development in the pathogenesis of NEC.Bile acids in the pathogenesis of NEC. Bacterial communities in the pathogenesis of NEC.The importance of immune cells in the pathogenesis of NEC.The role of nitric oxide signaling in the pathogenesis of NEC.The Silver Lining: The Small Intestinal Epithelial Barrier And Its Role In NEC.The Silver Lining: The Small Intestinal Epithelial Barrier And Its Role In NEC.Innate and adaptive immune dysfunction and NEC.Intestinal immune adaptation and NEC. Advancements in research on NEC pathogenesis and prevention using pigs. Small animal models for the study of NEC and "NEC in a dish".Nutritional Considerations in NEC.The Paneth cell and its role in the development of NEC.Human donor milk and NEC.The Genetic Basis of NEC Susceptibility. Anemia as a modifiable risk factor for NEC.Lipids and lipid metabolism in postnatal gut development and risk of intestinal injury.Machine Learning in NEC: challenges and opportunities.NEC risk from a maternal-fetal medicine perspective.Summary, future directions, novel therapies.
David J. Hackam, MD, PhD, FACS.
Pediatric Surgeon-in-Chief and Co-Director, The Johns Hopkins Children’s Center
Garrett Professor and Chief of Pediatric Surgery,
Professor of Surgery, Pediatrics, Cell Biology, and Genetic Medicine
Johns Hopkins University School of Medicine
Baltimore, Maryland , USA