AvanÁos em enterocolite necrosante Advances in necrotizing enterocolitis

Objective: To evaluate recently reported findings on necrotizing enterocolitis, paying particular attention to pathogenesis, management and preventative strategies. Data sources: The articles covered in this report consist of randomized and quasi-randomized trials, case control studies, metaanalyses and reviews published recently. Certain other articles were also included because of their utmost importance to the subject. Results: Necrotizing enterocolitis remains a major cause of morbidity and mortality in preterm infants. Those who are born with intra-uterinegrowth retardation are at a several-fold increased risk. Possible pathophysiologic processes beginning in utero and continuing after birth are discussed in this review. Other factors involved in the process are related to the role of arginine and the production of intestinal nitric oxide and the action of epidermal growth factor in the regulation of cell regeneration. Perforated necrotizing enterocolitis is a complex surgical problem; definitive evidence-based guidelines for the best approach are yet to be determined. After surgery, although residual small bowel length and the presence of the ileo-cecal valve remain important predictors of duration of parenteral nutrition in infants, other factors, such as the early use of breast milk or amino acid-based formula, may also play a role in intestinal re-adaptation. Prevention strategies have centered on feeding practices and emerging experiments such as amino acid supplementation, are also discussed. Conclusion: Significant results in terms of mortality and morbidity will be achieved through better understanding of necrotizing enterocolitis pathogenesis and clinical and surgical management in addition to the employment of preventative strategies. J Pediatr (Rio J). 2005;81(1 Supl):S16-S22: Necrotizing enterocolitis, prematurity, short bowel syndrome. Resumo Objetivo: Avaliar relatos recentes sobre a enterocolite necrosante, com especial interesse na etiopatogenia, manejo e prevenAao. Fonte dos dados: Os artigos utilizados nessa revisao consistem em ensaios randomizados ou semi-randomizados, estudos de casocontrole, metanAElises e artigos de revisao recentemente publicados. Alguns outros artigos foram selecionados devido ‡ sua import‚ncia para o tema. Resultados: A enterocolite necrosante O uma importante causa de morbimortalidade neonatal em prematuros. Entre esses, os nascidos com retardo de crescimento intra-uterino apresentam um risco mais elevado. O processo fisiopatolUgico inicia-se intra-œtero e continua apUs o nascimento. Entre outros fatores envolvidos na fisiopatologia, estao a aAao da arginina na produAao do Uxido nItrico intestinal e a aAao do fator de crescimento epidOrmico na regeneraAao celular. A perfuraAao intestinal ainda O um problema cirœrgico, e evidŒncias melhores quanto ‡ sua abordagem precisam ser avaliadas. ApUs a cirurgia, a extensao da alAa intestinal remanescente, a preservaAao da vAElvula ileocecal, assim como a utilizaAao precoce de leite materno ou soluAao de aminoAEcidos, sao determinantes na duraAao da nutriAao parenteral e no sucesso da readaptaAao intestinal. EstratOgias preventivas estao centradas nas prAEticas alimentares e, recentemente, na suplementaAao de aminoAEcidos. Conclusao: Com um melhor entendimento do processo fisiopatolUgico, do manejo clInico e cirœrgico, assim como das medidas de prevenAao, importantes resultados serao alcanAados em termos de