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Prevention of neonatal necrotizing enterocolitis
Insights
Acidifying infant feedings lowered stomach pH, reducing enteric bacteria. This significantly decreased the risk of necrotizing enterocolitis in premature infants, promoting healthy growth.
Area of Science:
- Neonatal Medicine
- Gastroenterology
- Infectious Disease
Background:
- Premature infants often have low stomach acid (hypochlorhydria).
- Stomach colonization by enteric bacteria is common in these infants.
- Bacterial colonization is linked to necrotizing enterocolitis (NEC) risk.
Purpose of the Study:
- To investigate if gastric pH influences enteric bacterial colonization.
- To determine if this colonization is linked to NEC risk or severity.
- To evaluate the effect of acidified feedings on NEC incidence.
Main Methods:
- Prospective, double-blind study comparing HCl-supplemented to water-supplemented feedings.
- Monitoring of gastric pH, bacterial counts, and NEC incidence/severity.
- Comparison of somatic growth rates between groups.
Main Results:
- HCl-supplemented group had lower median gastric pH (3.0 vs. 4.0).
- Lower gastric pH correlated with reduced bacterial colonization (p < 0.001).
- Significantly fewer NEC cases in the HCl group (1/34) vs. controls (8/34, p = 0.02).
Conclusions:
- Acidifying feedings to inhibit bacterial growth is effective.
- Lowering gastric pH significantly reduces NEC risk in premature infants.
- Acidification did not impede somatic growth in the studied infants.
Abstract:
Small premature infants are often hypochlorhydric, and frequently their stomachs are colonized by enteric, gram-negative bacteria. We tested a hypothesis that gastric pH affected the colonization of the stomach with enteric bacteria and that this colonization was causally related to the risk or severity of necrotizing enterocolitis. A prospective, double-blind study was conducted that compared a group of infants supplemented with 0.01-0.02 ml of 1 N HCl/ml of milk to a group with a similar supplement of water. Gastric pH, gastric enteric bacteria counts, and the incidence and severity of necrotizing enterocolitis were monitored. The median gastric pH of the HCl-supplemented group was lower (3.0) than controls (4.0) throughout the study (p less than 0.001). The gastric enteric bacterial colonization rate and the quantitative bacterial counts were strongly correlated with gastric pH over 4 (p less than 0.001). Somatic growth rates in infants in the HCl-supplemented group were equal to, or exceeded, those in the control group. There was 1 case of necrotizing enterocolitis among the 34 infants in the HCl-supplemented group and 8 cases among the 34 in the control group (p = 0.02). It appears that acidifying the feedings of small premature infants to a pH low enough to inhibit bacterial proliferation in the stomach significantly lowers the risk of necrotizing enterocolitis.