Nekrotizan Enterokolitte Önleyici Tedavi Seçenekleri

Nekrotizan enterokolit, yenidoğanları etkileyen en ciddi gastrointestinal sistem hastalığıdır. Çok düşük doğum ağırlıklı bebeklerin %5-10’unda görülmektedir. Yenidoğan yoğun bakım ünitelerindeki mortalite ve morbiditenin en sık nedenlerinden biridir. Hastalığın patogenezi tam olarak bilinmemekle beraber, prematürite ve düşük doğum ağırlığı en önemli risk faktörleridir. Güncel tedavi şemaları ile nekrotizan enterokolitin olumsuz gidişatı değiştirilememektedir. Bununla birlikte antenatal ve postnatal dönemde birtakım önlemler alınabilmektedir. Prematüre doğumların ve fetal gelişme geriliğinin azaltılması nekrotizan enterokoliti önlemede önemli role sahiptir. Antenatal steroid kullanımı ve anne sütü ile beslenme nekrotizan enterokolitten korunmada etkili gözükmektedir. Oral antibiyotikler etkili gözükse de güvenilirlikleri kanıtlanmamıştır. Beslenmeye arginin eklenmesi ile yapılacak yeni çalışmalara ihtiyaç vardır. Prebiyotiklerin nekrotizan enterokolitten korunmadaki etkileri kesin değildir. Probiyotikler etkili bulunmakla birlikte doz, zamanlama, tür ve riskli bebeklerde kullanımıyla ilgili cevaplanması gereken sorular mevcuttur. Nekrotizan enterokolitten korunmada standart kılavuzların geliştirilmesine gerek vardır.

Anahtar Kelimeler:

Nekrotizan enterokolit, önleyici tedaviler

PREVENTATIVE STRATEGIES IN NECROTIZING ENTEROCOLITIS

Necrotizing enterocolitis (NEC) is the most serious disease of newborn gastrointestinal tract. NEC affects 5-10% of very low birth weight infants. It is one of the most common causes of mortality and morbidity in neonatal intensive care units. Although pathogenesis of the disease is not clear, prematurity and low birth weight are the most significant risk factors. Poor prognosis of NEC could not be changed with current therapies. However, some preventive strategies can be used in the antenatal and postnatal period. Decreasing the incidence of premature births or poor fetal growth would have a major effect on the prevalence of NEC. Breast feeding and antenatal steroid therapy seem to be preventive for NEC. Although oral antibiotics seem to be effective, their safety is unclear. New studies are required with arginin supplementation. Prebiotics do not appear to be of benefit in prevention of NEC. Although probiotics seem to be effective, optimum strain, duration of supplementation, dose and safety in critically ill infants are the questions that have to be answered. The development of standard guidelines is required in the prevention of NEC

Keywords:

Necrotizing enterocolitis, preventive strategies,

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