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What causes Necrotizing Enterocolitis (NEC)? - Tala Talks NICU

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NEC is a horrible, horrible disease, that strikes (mostly) premature infants VERY suddenly. Watch this video the answer the following:
WHY is the gut SO different from every other organ in the body?
WHY do we have 100 trillion bacteria hanging out in the intestines?
WHY is the immature gut so susceptible to NEC?
AND
WHAT can we do to prevent NEC?
Please be sure to give us a like, comment about future topics, and subscribe to this channel to stay up to date on all things NICU! Also, click the notification bell after you subscribe to gain your weekly NICU knowledge as soon as it's loaded!
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Dr. Tala is a board-certified neonatologist, and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
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References:
Patel et al. Association of Red Blood Cell Transfusion, Anemia, and Necrotizing Enterocolitis in Very Low-Birth-Weight Infants. JAMA 2016 315 (9) 889-897
Clinical Report by American Academy of Pediatrics. Use of Probiotics in Preterm Infants
Pediatrics Volume 147, Number 6, June 2021
Shafir et al. Cochrane Library 2020. Probiotics to prevent necrotizing entercolitis in very preterm low birth weight infants
Quigley et al. Cochrane Library 2019. Formula versus donor breast milk for feeding preterm or low birth weight infants
Darling et al. Controlled Trial of Two Incremental Milk-Feeding Rates in Preterm Infants. N Engl J Med 381;15 October 10 2019
More et al. Association of inhibitors of gastric acid secretion and higher incidence of necrotizing enterocolitis in preterm very low birth weight infants. Am J Perinatol. 2013;30 (10); 849-856
Dasani et al. Standardized feeding regimen for reducing necrotizing enterocolitis in preterm infants: an updated systematic review. J Perinatol. 2017; 37 (7) 827-833
J. Neu and A. Walker. Necrotizing Enterocolitis N. Engl J Med 364;3 January 20 2011
J Neu. Necrotizing Enterocolitis: The Future. Neonatology 2020; 117:240-244
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**Timestamps**
1:11 General Facts about NEC
4:37 General Facts about the gut
12:23 Pathophysiology of NEC
16:11 What can we do to prevent NEC?
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Music: www.bensound.com (royalty free with credit)
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.

Опубликовано:

5 сен 2024

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Комментарии : 92

@kathybest9549 2 года назад

Thank you! I thought your presentation and delivery were excellent!

@TalaTalksNICU 2 года назад

Thank you so much Kathy. This is a relief! We were a little worried it was too long- but we couldn't decide what to remove! ha! Thanks for your positivity :)

@Yaya-cl3tu 2 года назад

Very informative video. My premature infant son passed away 14 years ago from this condition, and I was contacted recently to join a class action suit against Enfamil. I’m trying to educate myself as much as possible on the topic to determine if it’s the right choice for me. Reopening the wound may not be worth the emotional rabbit hole I’m finding myself spiraling back down. I’ve done too much emotional work to go back into that dark space.

@TalaTalksNICU 2 года назад

We're so sorry for your loss Yaya.(Tala here- not speaking for others) I don't think I can give you advice one way or the other. If donor breast milk is not available, then we are forced to use formula, because feeding with formula is better than not feeding, or feeding with anything else (excluding breast milk). I can't imagine what you've been through all these years. I hope whatever decision you make brings you closer to having moments of peace. XX

@mattyice8096 2 года назад

I am so sorry for your loss. Did they mention statue limitations? That's what I'm waiting to find out.

@toady1up 3 месяца назад

Praying for your peace, sweetheart

@edwardherbert7280 Год назад

If a Preparation is not being monitored by the FDA does not mean it is a Bad Preparation. The FDA supports many Medications that are far from healthy to administer, or take. Thank you so much for the Information about NEC.

@TalaTalksNICU Год назад

This is a really good point- and the other side is true too. We use many off label medications in the unit! Thank you

@caldoreo Год назад

A huge thank you, you did an amazing job and your energy radiates through the screen

@TalaTalksNICU Год назад

What a lovely compliment! Thank you so much!!

@fewdaysmukupa588 2 года назад

Thank you Dr, thank you for making these teaching simplified to version were we can understand 👏

@TalaTalksNICU 2 года назад

Hello Fewdays! That was definitely what we were trying to do, so were so happy to see your comment. Thank you so much!

@bernadetteanntabdi2545 2 года назад

I witnessed two events of NEC in our unit that is probably connected to blood transfusion. A. First baby was doing well, corrected age was 35 weeks, no antibiotics, long time on room air,oral feeding well and on full feeding, but with symptomatic anemia: desaturations, cyanosis. We gave 1dose of PRBC transfusion after 12H the patient had fever and then they found out it was NEC. 2. Preterm 27weeks of life, admitted at 25weeks, on CPAP, full feeds two days ago. Patient received 1dose of PRBC during hgb:9 and hct 27, feeding at 2-4ml every 2hours(not yet full feeds), with episodes of quick flashes of desaturation; After three days, patient is on full feeds with BM plus HMF, hgb:10. Patient then was given another blood transfusion, after few hours, abdominal girth increased and procalcitonin increased, patient became unstable and was diagnosed to have NEC.

@TalaTalksNICU 2 года назад

Ugh- agreed- these are such classical examples in the development of NEC. And the situations are so often heart breaking stories like this- healthy, growing babies who suddenly get sick (after a blood transfusion or not...) Thank you for sharing your examples- it's very impressive how you remembered the details- no doubt because they were so distressing to you. We hope they got through the sickness. Thanks again for sharing.

@bernadetteanntabdi2545 2 года назад

@@TalaTalksNICU So sad Dra. Tala because the 30 weeks just died last week.

@TalaTalksNICU 2 года назад

Oh that's awful. We're so sorry for the little baby, the family and the entire team.

@bernadetteanntabdi2545 2 года назад

@@TalaTalksNICU Thank you Dra. Tala.i am looking forward for your NICU videos. It is very helpful.

@goecmj Год назад

Thank you so much Dr. Tala, again, another home run! So many great pearls in this video. I really appreciated your details on going back to the pathophysiology/physiology. Some more ideas - SIP, CPAM? Thank you!!!

@TalaTalksNICU Год назад

All excellent ideas!!! We do need a separate video on SIP and CPAMs are so interesting- we’ll add both to list! Thank you so much again :)

@naitramsingh6942 2 года назад

As always excellent video, i have now, much more appreciation for gut pathophysiology, thank you and your team for all the hard work

@TalaTalksNICU 2 года назад

Oh yay! Thanks so much Naitram. We knew it was a lot of science- and we went back and forth about including it all- but again we felt like it's difficult to understand (what we know of) NEC without this background!

@sedofsedof6435 17 часов назад

Very nice dr tala ..it is very interesting

@kaneshamcdowell1231 2 года назад

Amazing lecture as always. Your lectures help me so much with school as I am studying to become a neonatal nurse practitioner.

@TalaTalksNICU 2 года назад

Congratulations on NNPschool- we hope you will love it! Let us know how it's going! We're so happy these lectures help you- comments like yours make our day!

@hannahbrown5517 2 года назад

thank you! i'm writing my dissertation on this subject, this was super useful!

@TalaTalksNICU 2 года назад

Oh wow! So glad this was helpful- and then be sure to check out the references we added. Good luck in your dissertation!

@hannahbrown5517 2 года назад

@@TalaTalksNICU thank you so much!

@user-ni7md2dq5j Год назад

Your videos are really helpful. Could you please do some surgical ones, like gastroschisis? TOF? Thank you for these videos

@TalaTalksNICU Год назад

Hello! Thanks Rachel- we are planning on a surgical series- we need more time! Actually asked a very smart friend to help with some! if you're referring to Tet- we did one video on tat disease process. Thanks for writing in!

@jasonheflin1416 2 года назад

When can we expect part 2? I loved this video and we even watched it in my NICU orientation.

@TalaTalksNICU 2 года назад

Oh wow Jason! That makes us so happy- that you’re all watching it during orientation! Part 2 will be the next video out- I wish we could go faster! Thanks for being here :)

@Harry1009ify Год назад

Thank you so much Tala. This is much appreciated. I do love this speciality and enjoy teaching on a range of topics. I certainly like what you teach. Great work.!

@TalaTalksNICU Год назад

Thank you SO much Harry! We're so glad you love neonatology and the teaching aspect! Thank you for taking the time to write!

@Tina-bo8kf 2 года назад

I'm grateful that I discovered you and your lessons, your videos help me a lot! Thank you for your time!❤

@TalaTalksNICU 2 года назад

Thank you Tina, for subscribing and for watching our videos! We're SO happy they're helping you clinically too :)

@paxtonmiller5052 2 года назад

This was a great video with so much good information! Thank you so much!

@TalaTalksNICU 2 года назад

Yay Paxton! So happy you're still watching! Hope you're doing well :)

@sydneyharris4457 2 года назад

More cardiac please!!! 💕

@TalaTalksNICU 2 года назад

Hello Sydney! We'll be filming a cardiac series in August- so give us a couple of months. I can't wait either!!

@stillbreathing100 2 года назад

Wonderful talk. Anxiously waiting for your new videos. Cleared a lot of concepts

@TalaTalksNICU 2 года назад

Hello! thank you again- for watching for taking the time to comment.This is my (Tala) favorite video, so I always appreciate it even more when somebody feels like it helped with concepts! We have a series on NEC- we hope you find them all helpful :)

@stillbreathing100 2 года назад

@@TalaTalksNICU it actually helped me to clear some core concepts of NEC in a very simple way! Now i feel more confident in treating it..👍🎈🎈🎈

@TalaTalksNICU 2 года назад

That's fantastic! Thanks so much for letting us know :)

@mohammadyrami 3 месяца назад

Thank you so much very informative

@TalaTalksNICU 2 месяца назад

Thank you so much for taking the time to comment!

@shijajacob3983 2 года назад

Great effort as usual Dr Tala,helping me a lot .Thank you 💜

@TalaTalksNICU 2 года назад

We’re so glad your still watching Shija! Thank you so much for your comment :)

@gugur6393 2 года назад

This is Helpful.. so Simplified and informative

@TalaTalksNICU 2 года назад

Thank you so much for letting us know- we're so happy you found it both simple and helpful!!!

@tamarajahmani5454 2 года назад

Very nice! I would request videos about NICU procedures Exchange transfusion PBD TGA Coarctation of aorta TPN calculations Hypotension in neonates Hypoglycemia

@TalaTalksNICU 2 года назад

Hello Tamara! Thanks for your excellent suggestions! We have filmed an exchange transfusion video already (can search for it under home page). And once we finish NEC we're starting fluids and electrolytes, and will make our way to TPN calculations. BPD we're hoping to get out in a month or so. We plan on filming a cardiac series sometime in the new year- starting with the cyanotic diseases. We are figuring out how to make videos on procedures- likely with a simulation doll. Unfortunately, all these videos take us such longer to plan, film and edit than we ever would have imagined, so please be patient with us!!! Thanks again for your excellent suggestions- we really appreciate you being here :)

@yvettemokum2615 2 дня назад

😢😢😢😢😢😢i lost my 26weeks weeker to this monster of a disease.she was already at 32weeks 😢.I'm still in shock

@TalaTalksNICU 2 дня назад

I’m so sorry- it’s a tragedy. I hope you find some peace and hope in these really dark times xxxx

@syahrainsuhaimi9758 2 года назад

Im really waiting for this ! Very good video indeed. Can i request a video on chronic lungs disease in neonate :)

@TalaTalksNICU 2 года назад

Were so happy you got something out of it, Syahrain! Thank you. CLD is our next 'big' topic planned, and we're really going to try to get it out before the end of the year. Thanks so much for being here :)

@joannanathan6703 2 года назад

Thanks for another evidence-based talk!

@TalaTalksNICU 2 года назад

Thank you so much Joanna- for watching and for commenting. We're trying to keep everything evidence based, but as you well know, even things we think we 'know', may end up proving very wrong!!! We'll see!

@drheshamelkordi8529 2 месяца назад

Thanks a lot My question is :did upgrading of antibiotics increase incidence of NEC in preterm with sepsis? and what is the relation bet sepsis and NEC?

@TalaTalksNICU Месяц назад

Yes- increased antibiotic usage early in the baby's life increases the incidence of the baby getting NEC.

@Harry1009ify Год назад

Hi Dr Tala, Really enjoyed your teaching and love your British accent. I wonder whether you can tell me whether it is possible to detect NEC/Sepsis early using blood gas. Recently I was helping a colleague resuscitating a baby who was exprem and was on CPAP and 2 hourly feeds via NGT; the baby was considered “stable” however in the early morning the baby had a cluster events including brady and desaturations: nobody checked baby’s blood gas as this baby was supposed to be a well baby. The day nurse took over and noticed this baby neing floppy accompanied with brady; the nurse then asked for a medical review for this baby and did a blood gas which showed PH was around 6.7 kPc; the baby deterioriated rapidly and we did a round of resusciation including chest compression and drug and the baby was intubated. About 2 hours later the baby had further events which required further resus (drugs+ chest compressions). It as confirmed through abdo Xray that this baby’sperforated- NEC. Sadly the baby died despite resus. My question is, would it make a difference, had someone done a blood gas 2-3 hours earlier and initiate treatment of triple Antibiotics and intubate baby? Would the baby be potenially saved? Obviouly there is no foul play as the death certificate would be issued. It was on my head and this question: could we have done better? Is NEC preventable? I very much appreciate your view: obviously this is just for my own practice learning purpose only. I would be grateful to hear from you. Many sincere thanks.

@TalaTalksNICU Год назад

URGH- I'm so sorry Harry1009ify....This is such a sad sad part of neonatology. I can't tell you the number of nights I haven't slept thinking "what if?"- and I'm pretty sure everybody in medicine would say same thing. Unfortunately though- there is a very aggressive version of NEC that can lead to shock and death pretty much whatever we do. Obviously there are so many other details I don't know about- but this seemed to happen extremely quickly. I'm so sorry for the little baby and their family.

@semsema72ibrahim98 2 года назад

thanks alot you are amazing and am interesting when I hear you're video

@TalaTalksNICU 2 года назад

That's so good to hear. Thanks so much for watching and for commenting :)

@monjidibrahim1168 2 года назад

V. Nice topic Well presented Thanks

@TalaTalksNICU 2 года назад

Thanks so much, as always so encouraging! We really appreciate it.

@TheKyli123456 6 месяцев назад

What about prebiotics for NEC prevention to avoid giving live bacteria?

@TalaTalksNICU 6 месяцев назад

Great question- prebiotics are basically foods that we can add to the milk that commensal bacteria will like and so hopefully will cause then to grow in numbers. Oligosaccharides are the classical prebiotics added to formula. Very small trials have been done which haven't really shown a difference in babies (Cochrane review: www.ncbi.nlm.nih.gov/pmc/articles/PMC10234253/pdf/CD015133.pdf)- so not really the life changing substance we would hope for. But also maybe not a lot to lose like you said- it's not live bacteria!

@donnamiller3687 2 года назад

Thank you for another great video, do you cover Neonatal Hypoglycaemia?

@TalaTalksNICU 2 года назад

Hello Donna- sorry took so long to get back to you. Thanks for your positive words. We haven't covered hypoglycemia yet- we definitely need to do that video sooner rather than later! Thanks so much :)

@Harry1009ify Год назад

Dear Tala Thank you so much for your reply which I appreciate very much. We did well as a team doing full resuscitation and supporting the baby’s family. My searching and thinking has been: is there anything one could do to spot the signs early; could for example, a blood gas be a possible predictor. I saw one research paper mentioning acidosis among others could be one of the predictors. Of course I always trach my students and new starters to adhere to infection control measures such as hand washing etc, observe abdomen, check on milk tolerance, promote breast feeding and teach parents to also be vigilant. What else can one do? Many thanks and I enjoy your channel- it is very high quality and we need someone like you to teach and raise awareness of neonatal intensive care. I, for sure love this speciality. Thank you again.

@TalaTalksNICU Год назад

Hello- yes- maybe a blood gas very early could have helped- but then do we immediately get blood gases on every baby with a couple of events? It's much easier to look back and think we did something wrong....I love that you are analyzing this so much. Clearly you love the specialty as much as we do :)

@godisinspirationenough2898 7 месяцев назад

Hey thank you, really a great video, I just would like to ask is the metabolic acidosis only because of the ischemia and subsequent accumulation of lactic acid or does it have another reason? Because the infants are normally also vomiting which would cause alkalosis?

@TalaTalksNICU 7 месяцев назад

Yes- the acidosis is usually an increased anion gap acidosis- and considered to be from lactic acidosis (infants cells not receiving the oxygen they need). When infants vomit they usually vomit some of their intestinal (alkali) juices too (hence the bile)- and so they don't lose a lot of acid this way. (An exception is pyloric stenosis when there is an obstruction at the end of the stomach). Usually if infants vomit a lot then theyre losing fluid and can become acidotic this way. But in NEC- its mostly a shock type picture. Hope this helps!

@kyleFed 2 года назад

thanks for the lecture. :)

@TalaTalksNICU 2 года назад

Thank you Karl! So glad you’re still here :)

@kyleFed 2 года назад

@@TalaTalksNICU yes! I love the videos! Curious if you ever thought about making videos on most common drips used in the NICU. Like precedex, fentanyl, morphine, versed/Milrinone etc. thanks.. Kyle!

@TalaTalksNICU 2 года назад

Oh that's a great suggestion Kyle. We had pressors/inotropes on our list but not pain meds/ sedatives. Thank you!!

@inalumieresonia9677 2 года назад

Can you do a video on feeding in prematures. Thanks

@TalaTalksNICU 2 года назад

As in, would you like a speech therapist to discuss feeding techniques, or do you mean just general information about what feeds we start at and general nutrition information?

@inalumieresonia9677 2 года назад

how feeds are given. TFI. How to calculate the fluids that are given in the first days of life and as well as the EBM

@TalaTalksNICU 2 года назад

Excellent! That's what we're getting to :)

@inalumieresonia9677 2 года назад

@@TalaTalksNICU great. Thanks!

@IloveRKC2113 2 года назад

Question. If a EBM providing mama is taking probiotics, does that transfer through the milk???

@TalaTalksNICU 2 года назад

Ohhh Amanda- this is a great question! The answer is, nobody really knows. babies DO get commensal bacteria from their mothers through the breast milk- this is more dependent on what is actually colonizing in their bodies. So if the probiotics the more ate actually reached the gut (instead of dying in the acidity of stomach etc), and then colonized the gut- Ie started multiplying and contributing to the mother's gut microbe, then yes- potentially babies could get it. So many ifs though! Probably not bad- but best thing for mamas is to eat healthily and a wide variety (which in itself should improve gut microbiota). Sorry- very grey answer!

@abelitasousa6053 3 месяца назад

How abouut the omeprazol dr Ttala?

@TalaTalksNICU 3 месяца назад

Not as well studied but works in a similar way so would definitely avoid if babies are still at higher risk of NEC. As babies get older some people could argue for their use.

@britneywebster2669 2 года назад

Is there any adjusted age for preemies where the risk of getting NEC when taking Zantac is decreased? I’ve seen many people hesitate to give reflux medication to preemies that are adjusted to 40+ weeks already so just curious!

@TalaTalksNICU 2 года назад

Hello Britney! We talk about this all the time- and the truth is we don't know! If a baby is preemie, we would really avoid giving it. As an extrapolation from there, we generally don't give it to babies in the NICU at all (under the logic that if they're still in the unit, then they're still having issues with something- normally with needing garage feeds). Sometimes shortly after leaving the unit, a pediatrician or GI doc will put the baby on Zantac immediately. Rarely we will use Zantac in the unit when a sub-specialist wants it. For example- surgeons want an anti-acid med when a baby has an esophageal atreisa/ TEF. ENT doctors ask for it too if the vocal cords are super-swollen etc. So in all- a very grey answer! Generally, avoid it altogether when the baby is in the unit (even if he is now 43 weeks...)

@user-wj8ec7mf1c 2 года назад

Does nexium also increase risk this point wasnt clear to me

@TalaTalksNICU 2 года назад

Hello! This is a great question. Generally we've never used Nexium (Esomeprazole) in the unit, so there aren't really studies including that drug. Studies with Prevacid (Lansoprazole) have been included with ranitidine and shown similar effects. Generally- since we're assuming they're doing a similar thing in the stomach (i.e. reducing acidity)- we try to avoid all these drugs in the unit.