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Novas perspetivas diagnósticas e terapêuticas na Enterocolite necrotizante : revisão narrativa da literatura científica
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A enterocolite necrotizante (NEC) é uma doença predominantemente associada à prematuridade, condicionando morbilidade e mortalidade elevadas, que permanecem praticamente imutáveis nas últimas duas décadas. O mecanismo fisiopatológico subjacente da NEC compreende uma extensa ativação da cascata inflamatória com consequente isquemia e necrose intestinal, podendo evoluir para a perfuração, peritonite, sépsis e morte. O conhecimento crescente dos fatores de risco interligados como a imaturidade gastro-intestinal, o tipo de nutrição entérica e a disbiose tem permitido a melhoria das estratégias preventivas. No entanto, na evolução da doença, a inespecificidade da apresentação clínica torna difícil o diagnóstico e tratamentos precoces que são essenciais para evitar o desfecho fatal. A abordagem terapêutica permanece igualmente inespecífica e reside na instituição da antibioterapia de largo espetro, no tratamento de suporte e, se possível, na intervenção cirúrgica. Decorrem há alguns anos investigações incidindo em novos biomarcadores precoces da doença e em abordagens terapêuticas como por exemplo fatores de crescimento ou as células estaminais. Neste enquadramento, este estudo tem como objetivo rever a literatura científica relativamente às novas perspetivas diagnósticas e terapêuticas da NEC. A metodologia foi baseada na pesquisa de publicações científicas de 2010-2023 nas bases PubMed/Medline e CENTRAL, através dos descritores definidos (recém-nascido; enterocolite necrotizante; diagnóstico; biomarcadores; tratamento). As conclusões da revisão visaram oferecer um ponto de situação quanto à abordagem da doença procurando a atualização científica e a mudança do paradigma da morbimortalidade associada à NEC.
Necrotizing enterocolitis (NEC) is a disease predominantly associated with prematurity, causing high morbidity and mortality, which have remained virtually unchanged over the last two decades. The pathophysiological mechanism of NEC comprises an extensive activation of the inflammatory cascade with consequent intestinal ischemia and necrosis, which can progress to perforation, peritonitis, sepsis and death. Growing knowledge of risk factors interconnected such as gastrointestinal immaturity, type of enteric nutrition and dysbiosis has allowed preventive strategies to be improved. However, as the disease progresses, the nonspecificity of the clinical presentation makes it difficult to diagnose and treat early, which is essential to avoid a fatal outcome. The therapeutic approach remains equally unspecific and consists of broad-spectrum antibiotics, supportive treatment and, if possible, surgical intervention. Research into new early biomarkers of the disease and therapeutic approaches such as growth factors or stem cells has been ongoing for some years. In this context, this study aimed to review the scientific literature on new diagnostic and therapeutic perspectives for NEC. The methodology was based on a search of scientific publications from 2010-2023 in the PubMed/Medline and CENTRAL databases, using the defined filters (newborn; necrotizing enterocolitis; diagnosis; biomarkers; treatment). The conclusions of the review aimed to provide an overview of the approach to the disease, seeking to update the scientifical knowledge and change the paradigm of morbidity and mortality associated with NEC.
Necrotizing enterocolitis (NEC) is a disease predominantly associated with prematurity, causing high morbidity and mortality, which have remained virtually unchanged over the last two decades. The pathophysiological mechanism of NEC comprises an extensive activation of the inflammatory cascade with consequent intestinal ischemia and necrosis, which can progress to perforation, peritonitis, sepsis and death. Growing knowledge of risk factors interconnected such as gastrointestinal immaturity, type of enteric nutrition and dysbiosis has allowed preventive strategies to be improved. However, as the disease progresses, the nonspecificity of the clinical presentation makes it difficult to diagnose and treat early, which is essential to avoid a fatal outcome. The therapeutic approach remains equally unspecific and consists of broad-spectrum antibiotics, supportive treatment and, if possible, surgical intervention. Research into new early biomarkers of the disease and therapeutic approaches such as growth factors or stem cells has been ongoing for some years. In this context, this study aimed to review the scientific literature on new diagnostic and therapeutic perspectives for NEC. The methodology was based on a search of scientific publications from 2010-2023 in the PubMed/Medline and CENTRAL databases, using the defined filters (newborn; necrotizing enterocolitis; diagnosis; biomarkers; treatment). The conclusions of the review aimed to provide an overview of the approach to the disease, seeking to update the scientifical knowledge and change the paradigm of morbidity and mortality associated with NEC.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Recém-nascido Enterocolite necrotizante Diagnóstico Biomarcadores Tratamento Pediatria