Dr. Isabelle De Plaen, MD, Neonatologist and Professor of Pediatrics at the Lurie Children’s Hospital of Chicago, talks about a health defect that affects premature babies, called NEC, and new treatments for it.
Interview conducted by Ivanhoe Broadcast News in April 2022.
Now, what is NEC?
DR DE PLAEN: So, NEC is a disease that is characterized by intestinal tissue, inflammation, and necrosis, which commonly leads to overwhelming sepsis and shock. So, it affects mainly premature infants, and it usually starts occurring after a week or two of life when the baby has recovered from the initial respiratory distress. They start getting fits and they suddenly develop abdominal distension, feeding intolerance, bloody stool, and they may develop then signs of shock, failure, they may have a tendency, they may stop breathing. They may need intervention for that. And they become lethargic. Some infants, on the other hand, are irritable because it’s a painful disease.
Is this a disease – I know you said preemies? Does it only happen in preemies?
DR DE PLAEN: So, it’s a good question. So, it takes – it affects mostly premature babies. And, for example, babies are born at less than 1,500 grams. It affects 4 to 8% of these infants. So, the incidence is quite high, but it can also affect infants that are not as premature and sometimes even term infants.
And then you think you take these little milestones in that first couple of days and then he’s hit with NEC. And is that how it usually happens because you…
DR DE PLAEN: And that’s usually – how it happens. And babies may be doing well the first few days and then suddenly develop this disease, which is quite insidious. And we still do not fully understand what causes NEC.
Can it be fatal?
DRDE PLAEN: It can be fatal. Mortality is around 20%.
And so how do you treat it?
DR DE PLAEN: So how do you treat NEC? So, there is no specific cure to treat NEC. But basically, current management includes stopping the feeds, decompressing the stomach by putting a tube and providing antibiotics via the vein and maintaining the blood volume. Because we want to keep maintaining the perfusion of the gut in the best we can and maintaining perfusion of the other organs. We provide pain control. We provide parenteral nutrition, and in about 30% of the case, surgery is required and usually a piece of gut gets removed. And we need to go to surgery when there’s either – when either intestinal perforation has occurred or when the babies deteriorate despite medical management.
So you’ve been able to find, which may lead to better treatments, exactly what’s causing this.
DR DE PLAEN: So basically, our laboratory has been focusing on studying the role of micro-vasculature development in the NEC. So how does this tiny blood vessels affect it in premature babies? What we knew about NEC is there’s several pathogenic mechanisms that seems to play a role in NEC. No. 1, the immature intestinal barrier. No. 2, an abnormal intestinal bacterial colonization in these premature babies. And No. 3, babies that are born premature tend to mount an exaggerated immune response and that cause intestinal tissue damage. But in addition, the immune response is immature and not very good at killing microbes. That then goes food to the intestinal wall and can cause infection. Now, what our lab, and we have some recent work that has demonstrated a role for the importance of the micro-vasculature development. So, the growth of the tiny blood vessels in the gut and how that plays a role in NEC. So, what we think is happening is that in – the in-utero environment is very low in oxygen, which is ideal for tiny vessels of the intestine to grow. Now, baby who’s – are born prematurely have to leave this environment. On top of that, the first few days they are – they don’t get adequate nutrition, plus they get all the perinatal stressors, and all these factors seems to play a role in affecting the growth of these tiny blood vessels. So, the blood vessels may be fine, to provide nutrients to the intestine at rest, but they may become too few once the intestine is required to now absorb nutrients and be colonized with bacteria. And that time it cannot – those vessels cannot sustain the metabolic demand of the intestine, which then this leads to that of the cells of the intestine and necrotizing enterocolitis. So, we think there’s several factors that play a role, but we think that the micro-vasculature play an important role. Now, and what we also found was that a type of fetal immune cells that are called embryonic macrophages are very important for the micro…
We were talking about other causes, Like the other causes.
DR DE PLAEN: Oh, yes. So let me go back. Explained – so we have found that in neonatal intestine, there is a type of immune cells called embryonic macrophages, which really help the micro-vasculature to develop and growth. And this is via producing a growth hormone. And we found that, interestingly, that premature infants who get NEC have much lower level of this growth hormone. And if we provide the growth hormone to neonatal mice that we submit to the NEC model, the little vessels of the gut grow better, and they are less susceptible to necrotizing enterocolitis. So, what we are studying now is how can we preserve these good cells that are so important for vessel growth in the gut so we could find and design therapy that could prevent NEC so babies would no longer need to suffer from this disease?
And in your mind, would it be something that any baby that’s born under, did you say, how many grams?
DR DE PLAEN: 1500 grams, you know, this will have to be determined.
So, could you tell me a little bit, do you remember, I know you probably deal with a lot of babies, but do you remember Sam?
DR DE PLAEN: Yes, I do remember Sam. Yes. Yes. And I remember how sick he was and how nice it was to see him recover and see him now growing and doing so well.
END OF INTERVIEW
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