|PhD ceremony:||S.J. Kuik|
|When:||September 14, 2020|
|Supervisors:||prof. dr. A.F. (Arend) Bos, J.B.F. Hulscher|
|Co-supervisor:||dr. E.M.W. Kooi|
|Where:||Academy building RUG|
Necrotizing enterocolitis (NEC) is the most severe gastrointestinal disease diagnosed in preterm infants. This thesis provides more insight in the pathophysiology of NEC, discuss novel tools to estimate chances of survival and intestinal recovery after NEC, and addresses underlying mechanisms associated with poorer neurodevelopment in preterm infants after NEC. First, we demonstrated that preterm infants are not able to increase intestinal oxygen delivery at younger gestational ages to meet increased metabolic demands after enteral bolus feeding. This may be one of the factors increasing the risk for developing NEC. Second, we found that the intestinal oxygen saturation, urinary intestinal-fatty acid binding protein levels, and plasma citrulline levels are potentially useful in estimating the chance of surviving surgery and predicting intestinal recovery in preterm infants after NEC. These findings will support clinicians to better estimate whether an infant would benefit from surgical intervention, counsel parents about their infants’ condition, and to adjust feeding regimens to the individual intestinal recovery rate. Third, we demonstrated that infants with NEC often display impaired cerebrovascular autoregulation during surgery, which may be a factor associated with poorer neurodevelopment. Furthermore, we found that the time to reach full enteral feeding after NEC onset was negatively associated with neurodevelopmental outcomes at the age of 2-3 years. Therefore, it seems important to reintroduce enteral feeding as soon as the intestine is recovered. Whether this is possible should be further investigated. The findings of this thesis will contribute to future individualized and improved NEC treatment and care.