Ischemia and necrotizing enterocolitis: Where, when, and how
Section snippets
Intestinal vascular anatomy
Arterial anatomy of the intestine can be divided into three segments based on function (Figure 1).3 The first segment begins with the two mesenteric artery trunks, the superior and inferior mesenteric arteries, that give rise to progressively smaller mesenteric arteries in a consecutive, tree-like branching pattern. This segment ends at the terminal branches of the mesenteric arterial arcade and functions as a conduit for delivery of blood to the gut wall. The second segment begins with the
When does ischemia occur?
Clearly, ischemia can cause intestinal damage; alternatively, however, it is possible that intestinal damage, caused by factors other than ischemia, reduces the need for perfusion (or eliminates the vascular space requisite for perfusion to occur), and so reduces intestinal blood flow. It is most likely that neither extreme is correct: ischemia is certainly not the sole basis for NEC-related tissue damage, while it is very likely that ischemia occurs at some time before complete tissue
Regulation of the newborn intestinal circulation
The most salient and distinguishing feature of the newborn intestinal circulation is its very low resting vascular resistance and hence high rate of blood flow when compared with older subjects. While myriad factors contribute to regulation of intestinal vascular resistance, two stimuli, one constrictor and one dilator, dominate control of vascular resistance within the newborn intestine.31
The principal constrictor stimulus in the newborn intestinal circulation is the peptide endothelin-1, or
Acknowledgment
This work is supported by the National Institute for Digestive Diseases, Diabetes, and Kidney (NIDDK), grant number DK065306 awarded to P. Nowicki, MD.
References (48)
- et al.
Role of platelet activating factor and tumor necrosis factor-alpha in neonatal necrotizing enterocolitis
J Pediatr
(1990) - et al.
The role of inflammatory cytokines and nitric oxide in the pathogenesis of necrotizing enterocolotis
J Pediatr Surg
(1997) - et al.
The pathogenesis of ischemic gastroenterocolitis of the neonate: selective gut mucosal ischemia in asphyxiated neonatal piglets
J Pediatr Surg
(1972) - et al.
Necrotizing enterocolitis in very low birth weight infants: biodemographic and clinical correlates
National Institute of Child Health and human Development Neonatal Research Network. J Pediatr
(1991) Epidemiology of necrotizing enterocolitis
Clin Perinatol
(1994)- et al.
An experimental study of acute neonatal entercolotis: the importance of breast milk
J Pediatr Surg
(1974) - et al.
Ischemic time-dependent microvascular changes and reperfusion injury in the rat small intestine
J Surg Res
(1995) - et al.
Revisiting ischemia and reperfusion injury as a possible cause of necrotizing enterocolitis: role of nitric oxide and superoxide dismutase
J Pediatr Surg
(2002) - et al.
Interleukin 1 increases the production of endothelin-1 by cultured endothelial cells
Biochem Biophys Res Commun
(1990) Nitric oxide synthase structure and mechanism
J Biol Chem
(1993)
Necrotizing enterocolitis
N Engl J Med
Pathology of neonatal necrotizing enterocolitis: a ten-year experience
J Pediatr
Intestinal microvascular adaptation during maturation of spontaneously hypertensive rats
Hypertension
Determinants of resting and passive intestinal vascular pressures in rat and rabbit
Am J Physiol
Mesenteric arcade arteries contribute substantially to vascular resistance in conscious rats
J Vasc Res
Pressure and flow characteristics of terminal mesenteric arteries in postnatal intestine
Am J Physiol
Lymphatic pathways and role of valves in lymph propulsion from small intestine
Am J Physiol
Mechanism of increased vessel wall nitric oxide concentrations during intestinal absorption
Am J Physiol
Intestinal lymphatic vessels release endothelial-dependent vasodilators
Am J Physiol
Surgical experience with necrotizing enterocolitis in the infant
J Pediatr Surg
The master switch of life
Sci Am
Effects of asphyxia on cardiac output and organ blood flow in the newborn piglet
Pediatr Res
Perinatal risk factors for necrotizing enterocolitis
Arch Dis Child
Effect of sustained mesenteric nerve stimulation on intestinal oxygenation in developing swine
Am J Physiol
Cited by (123)
Intestinal perfusion assessed by quantitative fluorescence angiography in piglets with necrotizing enterocolitis
2022, Journal of Pediatric SurgeryEarly cerebral and intestinal oxygenation in the risk assessment of necrotizing enterocolitis in preterm infants
2019, Early Human DevelopmentEpidemiology of Necrotizing Enterocolitis: New Considerations Regarding the Influence of Red Blood Cell Transfusions and Anemia
2019, Clinics in PerinatologyCitation Excerpt :Active expression of angiogenic factors in the metabolically active and rapidly proliferating gut mucosa ensures concomitant development of vascular structures in the intestine.53 It has been proposed that the developing thin arterioles may be structurally weak, and on exposure to an RBC transfusion and associated alterations in oxygen availability, blood pressure, flow, or viscosity, these arterioles are prone to injury, precipitating ischemic injury to the gut mucosa.5,54 However, experimental evidence is needed to confirm the proposed mechanisms.