1st Edition

Necrotizing Enterocolitis pathogenesis, diagnosis and treatment

Edited By David J. Hackam Copyright 2020

    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.

    List of Contributors

    1. Introduction: Necrotizing Enterocolitis, The Stories of Its Tiny Patients, and the Journey Ahead

    David J. Hackam

    2. Nursing Considerations in Necrotizing Enterocolitis: Management of Infant Stomas

    Margaret Birdsong and Michelle Felix

    3. Nursing Considerations in Necrotizing Enterocolitis: Management of Central Venous Catheters

    Margaret Birdsong and Michelle Felix

    4. An Updated Overview of the Medical Management of Necrotizing Enterocolitis

    Lila S. Nolan, Martin Goree, and Misty Good

    5. Clinical Clues, Biochemical Indices, and Biomarkers: Diagnostic Considerations in Necrotizing Enterocolitis

    Karl G. Sylvester and Enrico Danzer

    6. Imaging Considerations in NEC Diagnosis: Plain Films, Ultrasound, and Everything Else

    Emily A. Dunn

    7. Spontaneous Intestinal Perforation (SIP) Is Not Necrotizing Enterocolitis but Remains the Major Confounder of NEC Data

    Phillip V. Gordon, Jonathan R. Swanson, and Reese H. Clark

    8. International Practice Patterns in NEC Management: North America, Europe, and Australasia

    Maarten Janssen Lok, Carlos Zozaya, Sinobol Chusilp, and Agostino Pierro

    9. Feeding Strategies in the Patient with Necrotizing Enterocolitis

    Krista E. Cooksey, Olivia B. Parks, Angela N. Lewis, and Misty Good

    10. Surgery for Necrotizing Enterocolitis: Indications, Techniques, and Outcomes

    David J. Hackam

    11. Major Issues Related to Progress in NEC

    Josef Neu

    12. Probiotics in the Prevention of Necrotizing Enterocolitis

    Mark A. Underwood

    13. Cardiovascular, Hemodynamic, and Critical Care Considerations in the Patient with Necrotizing Enterocolitis

    Christine M. Cortelyou, Zachary A. Vesoulis, and Misty Good

    14. Neurodevelopmental Considerations in the Patient with Necrotizing Enterocolitis

    Panagiotis Kratimenos and Frances J. Northington

    15. Lung Disease and Ventilator Strategies in Necrotizing Enterocolitis

    Jegen Kandasamy and Namasivayam Ambalavanan

    16. Clinical Trials in NEC Research: Advances, Perils, and Pitfalls

    Cheryl Battersby, Chris Gale, and Neena Modi

    17. Management of Short Bowel Syndrome after Necrotizing Enterocolitis

    Ross Beckman and Samuel Alaish

    18. Necrotizing Enterocolitis in Unusual Cases: Term Infants, Congenital Anomalies, and Comorbidities

    Spencer W. Beasley

    19. Intestinal Transplantation for Necrotizing Enterocolitis

    Geoffrey Bond

    20. Optical Spectroscopy for the Detection of Necrotizing Enterocolitis

    Seth D. Goldstein

    21. Anesthetic Management of the Neonate with Necrotizing Enterocolitis

    John J. McCloskey

    22. Novel and Alternative Techniques in Surgery for Necrotizing Enterocolitis

    Maame Efua S. Sampah and David J. Hackam

    23. Supporting NEC Risk Awareness with Bedside Tools Like GutCheckNEC

    Sheila M. Gephart

    24. Health Economics and Care Delivery Issues in Necrotizing Enterocolitis

    Meredith E. Mowitz and John A. F. Zupancic

    25. Quality Improvement and Necrotizing Enterocolitis

    Minesh Khashu and Sunitha Vimalesvaran

    26. Implementation Strategies for Quality Improvement to Avoid Necrotizing Enterocolitis

    Sheila M. Gephart

    27. Clinical Outcomes in Children with NEC

    Mark D. Stringer

    28. Contextualizing Necrotizing Enterocolitis within Health Disparities Research

    Amaris M. Keiser

    29. Ethical Issues in the Care of Children with Necrotizing Enterocolitis

    Margaret R. Moon and Renee D. Boss

    30. Family Perspective of Necrotizing Enterocolitis

    Jennifer Canvasser

    31. The Role of Toll-Like Receptor Signaling in the Pathogenesis of NEC

    Maame Efua Sampah and David J. Hackam

    32. The Role of Growth Factor Signaling in the Development and Treatment of Necrotizing Enterocolitis

    Rita D. Shelby, Terrence M. Rager, Barrett P. Cromeens, and Gail E. Besner

    33. The Role of Platelet-Activating Factor in the Pathogenesis of Necrotizing Enterocolitis

    Michael Caplan

    34. The Role of Vascular Development in the Pathogenesis of Necrotizing Enterocolitis

    Isabelle G. De Plaen, Elizabeth Managlia, and Xiaocai Yan

    35. Bile Acids in the Pathogenesis of Necrotizing Enterocolitis

    Melissa D. Halpern

    36. Bacterial Communities in the Pathogenesis of Necrotizing Enterocolitis

    Brigida Rusconi, Misty Good, and Barbara Warner

    37. The Importance of Immune Cells in the Pathogenesis of NEC

    Andres Gonzalez Salazar and David J. Hackam

    38. The Role of Nitric Oxide Signaling in the Pathogenesis of Necrotizing Enterocolitis

    Anatoly Grishin, Patrick T. Delaplain, Jin Wang, Michael Mallicote, Michelle Nguyen, Michael Philippe-Auguste, Christopher P. Gayer, and Henri R. Ford

    39. The Silver Lining: The Small Intestinal Epithelial Barrier and Its Role in Necrotizing Enterocolitis

    Mark R. Frey, Misty Good, and Steven J. McElroy

    40. Innate and Adaptive Immune Dysfunction and Necrotizing Enterocolitis

    Paula Osterhout, Christina S. Kim, and Erika C. Claud

    41. Intestinal Immune Adaptation and Necrotizing Enterocolitis

    Mathias W. Hornef

    42. Advancements in Research on Necrotizing Enterocolitis Pathogenesis and Prevention Using Pigs

    Douglas Burrin, Juan Marini, Murali Premkumar, Barbara Stoll, and Per Torp Sangild

    43. Small Animal Models for the Study of Necrotizing Enterocolitis and "NEC-in-a-Dish"

    Mark L. Kovler, Chhinder P. Sodhi, and David J. Hackam

    44. Nutritional Considerations in Necrotizing Enterocolitis

    Jae H. Kim

    45. The Paneth Cell and Its Role in the Development of NEC

    Brian A. Juber and Steven J. McElroy

    46. Human Donor Milk and Necrotizing Enterocolitis

    Maggie Meeks and Rachael Lamb

    47. The Genetic Basis of NEC Susceptibility

    Lovya George, Wei Yu, Alain Cuna, and Venkatesh Sampath

    48. Anemia as a Modifiable Risk Factor for NEC

    Ravi Mangal Patel

    49. Lipids and Lipid Metabolism in Postnatal Gut Development and Risk of Intestinal Injury

    Camilia R. Martin

    50. Machine Learning in Necrotizing Enterocolitis: Challenges and Opportunities

    Jennine Weller and David J. Hackam

    51. Necrotizing Enterocolitis Risk from a Maternal-Fetal Medicine Perspective

    Mark L. Kovler, Savannah Ireland, Angie C. Jelin, and Eric B. Jelin

    52. Future Directions and Research Opportunities in NEC: The Top Ten Unanswered Questions and Top Five Areas of Research Focus

    David J. Hackam



    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

    "This book organizes an immense amount of information in a way that is
    appropriate for novice medical students as well as the most seasoned bedside
    nurses...this book has no comparison."

    Jessica A Zagory, MD, Louisiana State University Health Sciences Center