Role of Platelet-Activating Factor in Necrotizing Enterocolitis in Pediatric Patients

Necrotizing enterocolitis (NEC) is a serious gastrointestinal disease primarily affecting premature and very-low-birth-weight infants, with an incidence of 1-7% among NICU admissions and up to 10% in infants weighing less than 1500 grams. Clinical presentation often includes feeding intolerance, abdominal distension, bloody stools, and signs of systemic illness such as temperature instability, apnea, and lethargy. Mortality rates remain high, especially in severe or surgically managed cases, underscoring the need for early recognition and intervention. The development of NEC is influenced by a range of factors, including gestational age, birth weight, chorioamnionitis, and genetic predisposition, all of which have been previously explored, shedding light on the multifactorial nature of NEC initiation. Platelet-activating factor (PAF), a proinflammatory phospholipid, plays a crucial role in diverse physiological and pathological processes, influencing cellular functions, apoptosis, inflammation, and wound healing through de novo and remodeling pathways. Dysregulation of PAF is implicated in various diseases, including NEC. This review will explore the role of PAF throughout the development and progression of NEC in pediatric patients, the pathways activated by PAF, its impact on inflammatory cascades, vascular integrity, and immune modulation within the intestinal tract. Finally, we will assess therapeutic interventions targeting PAF in NEC management and evaluate the efficacy and limitations of current therapeutic intervention strategies.