Researchers at Stanley Manne Children's Research Institute at Ann & Robert H. Lurie Children's Hospital of Chicago and colleagues discovered a promising direction toward understanding the development of necrotizing enterocolitis (NEC), a devastating intestinal disease commonly affecting premature infants, in order to treat it.

Necrotizing Enterocolitis 

( NEC ) Is a medical condition where a portion of the bowel dies. It usually occurs in newborns that are either premature or otherwise unwell. Symptoms may include poor feeding, bloating, decreased activity, blood in the stool, or vomiting of bile.

The exact cause is unclear. Risk factors include congenital heart disease,  birth asphyxia, exchange transfusion, and prolonged rupture of membranes. The underlying mechanism is believed to involve a combination of poor blood flow and infection of the intestines. Diagnosis is based on symptoms and confirmed with medical imaging.

Studying the early cellular events leading to NEC in a mouse model, they found that activation of a key protein (transcription factor NF-κB), which Responds to stimuli like bacterial products, triggers inflammation in the intestine Prior to the presence of intestinal injury.

Blocking NF-κB activity prevent recruitment of bone marrow-derived monocytes (a type of white blood cells) into the intestine and their subsequent differentiation into macrophages (immune cells involved in the inflammatory response but also tissue damage when unregulated). This process decreased the development of NEC. Their findings were published in the  American Journal of Pathology.

"The researcher study points to a new potential strategy for preventing NEC during the first few weeks of life in premature babies who are at high risk for the disease, "says senior author Isabelle G. De Plaen, MD, neonatologist and researcher at the Manne Research Institute at Lurie Children's, who is also an Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine.

"If they could intervene early to prevent excessive inflammation caused by monocyte recruitment before signs of NEC were found, we could substantially improve outcomes for these babies."

Inflammation is involved in NEC andThe damaged intestinal tissues often need to be surgically removed. The resulting short gut is not always sufficient to sustain survival. Damaged intestinal tissue also allows bacterium normally confined inside the intestinal cavity to leak into the abdomen and cause infection.

This process can be overwhelming to a baby and possibly fatal. Because the exact causes of NEC are unclear , no specific treatment is currently available and prevention remains a challenge.

"By investigating the earliest inflammatory events in NEC, we come to a lot closer to developing the means to interrupt mechanisms that contribute to this disease," says Dr. De Plaen.