Since early presentation of NEC can be subtle, high-clinical suspicion is important when evaluating any infant with signs of feeding intolerance or other abdominal pathology (52). Generally, continuing feeding a patient with developing NEC worsens the disease. Prophylaxis with oral aminoglycosides has been shown either to reduce the incidence of NEC especially in low birth infants or to have no appreciable effect (5,53). The use of prophylactic oral aminoglycoside antibiotics carries the risk of emergence of resistant bacteria, including clostridia (52). This argument is bolstered by the description of colitis caused by C. difficile in a newborn (54). This is also important because clostridia have been implicated in the etiology of NEC (5) or NEC-like illnesses (14-23,28-34), and these organisms are resistant to the aminoglycosides and polymyxins. Direct gastrointestinal injury by aminoglycosides and their systemic absorption may also have an adverse effect. Because endemic NEC occurs too infrequently and unpredictably, the routine administration of oral antibiotics is not warranted. However, during epidemics, especially those associated with specific organisms, appropriate prophylaxis may be indicated.

Breastfeeding may reduce the risk of NEC. Antenatal corticosteroids can reduce the incidence of NEC (55,56). Based on the available trials, the evidence does not support that the administration of oral immunoglobulin prevents NEC. There are no randomized controlled trials of oral IgA alone for the prevention of NEC (57). Avoidance of hypertonic formulas, medications, diagnostic agents, phlebotomy, placement of venous umbilical catheters in the portal vein, and performing exchange transfusion with plasma when polycythemia is critical or helpful (52).

Two studies (9,10) demonstrated a significant benefit for the use of oral probiotics [one using Lactobacillus acidophilus and Bifidobacterium infantis (10) and the other Bifidobacterium infantis, Streptococcus thermophilus, and Bifidobacteria bifidus (9)] in the prevention of NEC. They confirm previous observations in experimental animal models (58,59) and findings in studies involving premature infants (60).

The mechanisms by which probiotics may protect from NEC include: shifting the intestinal balance from a microflora, which is potentially harmful to the host, to one, which is predominantly beneficial (61); strengthening the intestinal mucosal barrier function, thereby impeding translocation of bacteria or their products; and modification of host responses to microbial products (62).

Probiotics appear to be safe in neonates. However, the rare complication of sepsis is of concern. In a recent report (63) two patients, a six-week-old and a six-year-old, who received probiotic lactobacilli, developed bacteremia and sepsis attributable to Lactobacillus spp. Molecular DNA fingerprinting analysis showed that the Lactobacillus strain isolated from blood samples was indistinguishable from the probiotic strain ingested by these patients.

Even though two studies (9,10) support a role for probiotics in the protection from NEC, the use of probiotics in neonates must be better understood and its advantages and potential risks need further confirmation before it becomes a general practice.

Routine infection-control measures, such as glove-gown-cohort-isolation and good handwashing are of utmost importance especially in preventing and controlling outbreaks. Cohorting of infants and personnel are important. Caregivers with concurrent illnesses should not work in the nursery.

New Mothers Guide to Breast Feeding

New Mothers Guide to Breast Feeding

For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.

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